Health Rounds: Once-weekly insulin from Eli Lilly appears effective as daily injections

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10/09/2024 20:43

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    By Nancy Lapid
       Sept 10 (Reuters) - Hello Health Rounds Readers! Today
we feature a trio of studies from the ongoing European
Association for the Study of Diabetes meeting in Madrid,
including a trial that moves a once a week insulin shot closer
to reality.  
    
    Lilly’s once-a-week insulin effective as daily shots
    Eli Lilly’s  LLY.N  experimental insulin that is injected
just once a week is as effective as daily insulin injections for
maintaining blood sugar levels in patients with type 1 or type 2
diabetes, researchers said on Tuesday at the European
Association for the Study of Diabetes meeting in Madrid.
    In two late-stage trials, they compared blood sugar
management over the course of a year with weekly injections of
insulin efsitora alfa or daily injections of insulin degludec.
One trial involved 623 participants with type 1 diabetes, while
the other included 928 patients with type 2.
    In both trials, hemoglobin A1c levels – a measure of blood
sugar control over the previous three months – improved to a
similar extent with efsitora and degludec.
    Figuring out the right dose of efsitora was trickier in type
1 patients, however. These patients experienced more episodes of
low blood sugar known as hypoglycemia with efsitora,
particularly in the first 12 weeks of treatment, according to a
report of the trial published in The Lancet.
    "More work is needed to evaluate efsitora dose initiation
and optimization" to maintain efficacy while mitigating the risk
of hypoglycemia in people with type 1 diabetes, study leader Dr.
Richard Bergenstal of the HealthPartners Institute in
Minneapolis said in a statement. 
    Participants with type 2 diabetes were being newly
transitioned to insulin after other medications failed to keep
their blood sugar levels in the target range. 
    For these patients, “a once-weekly insulin has the potential
to simplify dose administration and diminish barriers to
starting insulin therapy by means of a reduction in injection
burden,” Dr. Carol Wysham of the MultiCare Rockwood Center for
Diabetes and Endocrinology in Spokane, Washington wrote in a
report in The New England Journal of Medicine. 
    Efsitora and degludec are so-called basal insulins, intended
to keep blood sugar levels stable when patients are not eating.
Everyone with type 1 diabetes in the trial also used a
short-acting insulin at mealtimes.
    In July, Lilly rival Novo Nordisk  NOVOb.CO  failed to
secure U.S. approval for its own once-weekly basal insulin
icodec injection.

    Air travel may affect insulin pumps 
    People with type 1 diabetes who wear insulin pumps should
know that altitude changes during air travel can cause
unintended insulin delivery, researchers said at the diabetes
meeting in Madrid.
    They recommend temporarily disconnecting insulin pumps
before take-off and removing air bubbles before reconnecting
them at cruising altitude.
    The researchers monitored insulin delivery from 26 pumps in
tests conducted in Europe’s largest hypobaric chamber, to mimic
the atmospheric changes during a normal commercial flight. 
    The hypobaric chamber was de-pressurised during a simulated
ascent and a 30-minute cruise, mimicking an airline pressurized
cabin altitude of 8,000 feet. The ambient pressure was then
increased during a 20-minute “descent” to ground level. 
    During the 20-minute ascent simulation, insulin cartridges
over-delivered 0.6 units of insulin, an amount unlikely to lead
to clinically significant or symptomatic low blood sugar
episodes, the researchers said. 
    During descent period, when pressure was rising, the
cartridges under-delivered 0.5 units of insulin, potentially
leading to blood glucose being somewhat higher than usual.
    “Whether these abnormalities in insulin delivery during
flights cause clinical effects will depend on several factors,
including an individual’s insulin sensitivity, food intake, and
glycemic control,” study leader Dr. Ka Siu Fan from the Royal
Surrey County Hospital and University of Surrey, UK said in a
statement.
    The researchers also simulated a sudden loss of cabin
pressure such as would occur in an emergency. This could result
in the delivery of 5.6 units of excess insulin, which could
cause significant hypoglycemia, or dangerously low blood sugar,
the researchers found. 
    
  
    Hydrogel could reduce semaglutide shots to once a month
    An experimental drug delivery system could cut the dosing
schedule for Novo Nordisk’s obesity and type 2 diabetes drugs,
Wegovy and Ozempic, from once a week to once a month, French
researchers reported at the Madrid diabetes meeting.
    Semaglutide, the active ingredient in both drugs, would be
delivered in a hydrogel that allows slow, sustained release of
the drug over 1 to 3 months, researchers said. 
    A small dollop, known as a "depot," of the semaglutide-laden
hydrogel is injected under the skin using commercially available
hypodermic needles, Dr. Claire Megret from manufacturer Adocia
 ACOC.PA  in Lyon explained. 
    The gel has not yet been tested in large animals or humans. 
    “Our pre-clinical results demonstrate that the regular, slow
release of semaglutide over one month after administering a
single dose, with limited early release, is achievable,” Megret
said.
    “Next we will be testing the hydrogel platform in pigs,
whose skin and endocrine systems are most similar to those in
humans," she said, adding that clinical trials in humans was
possible within the next few years.


 (Reporting by Nancy Lapid; editing by Bill Berkrot)
 ((Nancy.Lapid@thomsonreuters.com))