Q&A: Key Things Pharmacists Need to Know About Insulin Icodec
Jennifer Goldman, PharmD, CDCES, BC-ADM, FCCP, discusses a recent meta-analysis that evaluated the efficacy, safety, and clinical implications of insulin icodec.
Insulin icodec, a human insulin analog formulation administered subcutaneously once weekly, is a promising therapy for patients with diabetes that may help increase adherence rates. In a recent metanalysis, investigators evaluated the efficacy, safety, and clinical implications of insulin icodec. The study concluded that insulin icodec could potentially improve treatment adherence and quality of life for patients with diabetes and that it represents a “significant innovation in insulin therapy.”1
Q&A: Key Things Pharmacists Need to Know About Insulin Icodec / Sherry Young - stock.adobe.com
Jennifer Goldman, PharmD, CDCES, BC-ADM, FCCP, lead author on the study and a professor of pharmacy practice at Massachusetts College of Pharmacy and Health Sciences, recently sat down with Drug Topics to discuss how insulin icodec differs from existing daily basal insulins, important findings from the study, if the FDA’s decision will negatively impact patients with diabetes, and key things pharmacists need to know about the therapy.
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Drug Topics: What are some key things pharmacists need to know about insulin icodec?
Jennifer Goldman, PharmD, CDCES, BC-ADM, FCCP: I think that this is going to be critical. I think it's important to consider who's a candidate for icodec and [if] you have patients who are not adherent to basal insulin, [they] would certainly be a good candidates. When we think about what happened with GLP-1 receptor agonists, and it was available once a day, and then once a week, once a week has made such a significant impact in patients being able to remember to take their medications. I think that's one of the things pharmacists need to be aware of.
The absolute biggest thing is going to be dosing. Dosing is going to be critical. One thing everyone needs to understand is one unit is one unit. One unit of icodec is the same as one unit of any other basal insulin, except it's given in a one-time dose, so it's seven times that dose, but it's once a week. I think that people are going to get caught up with 70 units being 10 units a day, and so pharmacists have to remember that, because they're going to need to give a lot of education. Pharmacists are going to be critical in the community. For providers who are prescribing icodec, they have to be able to look at that dose and know that that starting dose, or the transition dose, is appropriate. If somebody is concerned, for example, “How do you start someone on 70 units of insulin?” It sounds scary, but they have to remember it's not 70 units once a day. It's 70 units with a slow release, so that it's once a week. It's equivalent of starting someone on a typical basal dose of 10 units. That's going to be important.
Same thing with the titration. The titration may be 20 units a week, and they have to understand that you need to divide that by seven in order to understand that that's a daily increase of a couple of units. It's going to need to be done mathematically. I think, not only are providers and prescribers going to be concerned, but our patients also [are too] if they're switched. Pharmacists in the community are often the last touch point that a patient has before they go home. Community pharmacists are going to be critical.
Drug Topics: Is there anything else you would like to say about insulin icodec that we haven’t touched upon?
Goldman: I am excited for innovation. Davida Kruger, who is one of the one of my mentors, and someone I just admire so much, she likes to say that continuous glucose monitoring (CGM) is a right, not a privilege, and I totally believe that. Utilizing CGM in people with diabetes is certainly going to be able to help patients understand what's happening in their body. All pharmacists out there [should] recommend CGM for all patients on insulin. The other thing [is to recommend] ready to use glucagon when you're filling prescriptions for anyone getting insulin, whether it's a new once a week or it's once a day, everyone should have access to ready to use glucagon. I think that pharmacists are going to be in a very unique and special position here to be involved and able to really get into relationships with their patients and with their providers in this situation.
READ MORE: Diabetes Resource Center
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