Maintaining effective glycemic control while minimizing hypoglycemia is a major goal in type 2 diabetes management. This study was presented at the European Association for the Study of Diabetes Congress 2025. 

Post hoc analyses of ONWARDS trials 1 through 5 compared once-weekly insulin icodec with once-daily basal insulin comparators in insulin-naive and insulin-experienced adults. Outcomes were stratified by baseline HbA1c (≤8%, >8–≤9%, >9%).

Across most trials, icodec produced numerically greater HbA1c reductions than once-daily insulin in all HbA1c subgroups, with exceptions in the basal-bolus ONWARDS 4 trial for the higher HbA1c groups. Importantly, no statistically significant interaction was observed between baseline HbA1c and treatment effect for HbA1c change or for achieving HbA1c <7% without clinically significant or severe hypoglycaemia. Overall, hypoglycaemia rates were low (<1 event per patient-year) across groups, apart from slightly higher rates in both arms of ONWARDS 4.

These results indicate that once-weekly icodec provides consistent glycaemic efficacy and safety across diverse baseline HbA1c levels, offering a flexible and potentially convenient basal insulin option for adults with type 2 diabetes.