Once-Weekly Insulin Icodec Strengthens the Case for CGM Use in Primary Care

Once-weekly insulin doesn't require a referral to endocrinology by default, Rachael Sood, NP-C, CDCES, founder and CEO of the Diabetes Collective, told Patient Care Online in a recent interview. Any clinician comfortable initiating basal insulin, whether daily or weekly, can manage it in primary care. The bigger practice shift, she said, is likely to be the growing role of continuous glucose monitoring (CGM), since CGM lets both patients and clinicians see glucose trends more clearly than intermittent fingersticks allow.

The single most important thing for primary care physicians to understand, Sood said, is what happens when a dose is missed. Because insulin icodec's half-life is considerably longer than daily basal insulins, a patient who forgets to dose on schedule — even by three or four days — still has meaningful insulin coverage, and can simply take the dose when they remember. That said, she was clear that hypoglycemia risk doesn't disappear with once-weekly dosing; the insulin's long duration of action means the risk profile looks different, not absent, from daily basal insulin.

Sood, who said she hasn't practiced without CGM in roughly a decade, argued that dosing insulin based on just three or four fingersticks a day leaves clinicians largely blind to what's happening across the rest of a patient's day — and she expects once-weekly insulin to accelerate CGM adoption among clinicians who haven't yet incorporated it into their practice. She also pointed to clinical trial data behind insulin icodec's approval, noting hemoglobin A1C reduction was comparable to — and in some analyses modestly better than — daily basal insulin in adults with type 2 diabetes, with reductions of roughly 1% or more.

Sood has no relevant disclosures to report.