There are several new medications for type 2 diabetes currently in development. One is a once a week insulin injection, the other is a combined insulin and GLP-1 agonist daily injection.

Research with once weekly insulin

Insulin icodec is a basal insulin that is designed to be administered once weekly. It is currently in the research and development phase and is not available for use.

Research of a phase 2 trial of insulin icodec was recently published in the New England Journal of Medicine. It compared the use of once weekly insulin icodec with daily insulin glargine (also known as Lantus or Optisulin) injections. There were 247 participants in the trial, which lasted 26 weeks. It concluded that the once weekly insulin icodec had a safety profile and glucose lowering profile similar to insulin glargine.

While insulin icodec is only in the research and development phase, the potential to reduce basal insulin injections from daily to weekly injections, is very exciting.

Combination daily insulin/GLP-1 RA injections

Treatment for type 2 diabetes can involve daily insulin injections and daily or weekly injections of the non-insulin injectables medications known as glucagon-like peptide 1 receptor agonist (GLP-1 RA). A combination medication of insulin and GLP-1 RA would help to reduce the daily burden load of injections to treat type 2 diabetes.

One such medication, known internationally as Xultophy, is available overseas and was recently approved by the Therapeutics Goods Administration (TGA).

Xultophy is a combination medication of two medications, including insulin degludec 100units/mL and a non-insulin injectable known as liraglutide 3.6mg/mL. Insulin degludec is an ultra-long acting basal insulin that is currently available in the combination insulin Ryzodeg. Liraglutide (trade name Victoza) is from the group of medications known as GLP-1 receptor agonists.

The Australian Register of Therapeutic Goods (ARTG) approved Xultophy in December 2020; however, there is no known framework when this medication may become available in Australia.

If Xultophy does make it to Australia, it is a once daily injectable, indicated as an addition to diet management and exercise for the treatment of adults with type 2 diabetes to improve blood glucose management in combination with metformin, with or without other oral glucose-lowering medications.

The future

These medications are currently not available in Australia. However, research is focused on combination medications to reduce the burden of daily injections in the treatment of type 2 diabetes.

By Alison Crow Pharmacist, CDE