Type 2 Diabetes and Insulin Use
PA Orr opens the series with a quick review of how type 2 diabetes progresses, from insulin resistance to beta-cell overload, and when the ADA Standards of Care point to insulin initiation. She also looks at why so many patients struggle with insulin, including needle phobia, overwhelm, mobility challenges, and the burden of daily injections.
She then introduces the two newly approved once-weekly basal insulins, insulin icodec and insulin efsitora alfa. PA Orr explains how each works and why weekly dosing may improve persistence and adherence, drawing on evidence from weekly GLP-1 receptor agonists and on patient and provider interest.
Key Takeaways:
- Insulin resistance and beta-cell dysfunction are the key drivers of type 2 diabetes progression.
- Non-adherence to treatment with insulin is present in ~50% of patients.
- We can now offer appropriate patients weekly basal insulin, reducing their injection burden from 365 to 52 per year.
Speaker
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References and Additional Resources:
American Diabetes Association Professional Practice Committee for Diabetes; 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49 (suppl 1):S183–S215. https://diabetesjournals.org/care/article/49/Supplement_1/S183/163934/9-Pharmacologic-Approaches-to-Glycemic-Treatment
Bajaj HS, Goldenberg RM. Insulin icodec weekly: a basal insulin analogue for type 2 diabetes. touchREV Endocrinol. 2023;19(1):4-6. https://pmc.ncbi.nlm.nih.gov/articles/PMC10258611/
Galdón Sanz-Pastor A, Justel Enríquez A, Sánchez Bao A and Ampudia-Blasco FJ. Current barriers to initiating insulin therapy in individuals with type 2 diabetes. Front. Endocrinol. 2024;15:1366368. https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2024.1366368/full
Galicia-Garcia U, Benito-Vicente A, Jebari S, et al. Pathophysiology of type 2 diabetes mellitus. Int J Mol Sci. 2020;21(17):6275. https://pmc.ncbi.nlm.nih.gov/articles/PMC7503727/
Henry RR. Type 2 diabetes care: the role of insulin-sensitizing agents and practical implications for cardiovascular disease prevention. Am J Med. 1998;105 (suppl 1A):3S–8S. https://pubmed.ncbi.nlm.nih.gov/9707264/
Kerr D, Rajpura JR, Namvar T. Evaluating Patient and provider preferences for a once-weekly basal insulin in adults with type 2 diabetes. Patient Prefer Adherence. 2024;18:411-424. https://www.dovepress.com/evaluating-patient-and-provider-preferences-for-a-once-weekly-basal-in-peer-reviewed-fulltext-article-PPA
Polonsky WH, Arora R, Faurby M, Fernandes J, Liebl A. Higher rates of persistence and adherence in patients with type 2 diabetes initiating once-weekly vs daily injectable glucagon-like peptide-1 receptor agonists in us clinical practice (STAY study). Diabetes Ther. 2022;13(1):175-187. https://pmc.ncbi.nlm.nih.gov/articles/PMC8776963/
Skriver LKL, Nielsen MW, Walther S, Nørlev JD, Hangaard S. Factors associated with adherence or nonadherence to insulin therapy among adults with type 2 diabetes mellitus: A scoping review. J Diabetes Complications. 2023;37(10):108596. https://pubmed.ncbi.nlm.nih.gov/37651772/
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