Adherence to an app-based insulin dosing guide was linked to better glucose control and optimized titration among people with type 2 diabetes (T2D) initiating once-weekly insulin icodec, according to a new post-hoc analysis of the ONWARDS 5 Phase 3a trial, published in Diabetes, Obesity, and Metabolism.

Inadequate basal insulin titration is a well-known barrier to optimal glycemic control in T2D. Digital tools may help improve adherence to dose adjustment protocols. Insulin icodec, a once-weekly basal insulin analogue, has been developed to simplify initiation and management compared with once-daily basal insulins.

The ONWARDS 5 trial (NCT04760626) randomized 1,085 insulin-naïve adults with T2D to once-weekly insulin icodec with app-based dose guidance (n=542) or once-daily basal insulin analogues (n=543). Participants in the icodec arm used a cloud-based app to record self-measured blood glucose (SMBG), insulin doses, and hypoglycemic events. Dose adjustments were suggested by an algorithm and could be reviewed by healthcare professionals (HCPs).

Limitations included device accessibility, strict eligibility criteria, and the 52-week trial duration, which may limit real-world generalizability.

“These results show that patients were highly engaged with the dosing guide app,” the authors wrote. “Greater adherence was linked to better glucose outcomes and higher insulin doses, underscoring the role of digital tools in supporting insulin initiation and titration.”

The analysis was funded by Novo Nordisk, developer of insulin icodec. Several authors reported industry affiliations.