Exercise or Fasting in Individuals With Type 2 Diabetes Receiving Once‐Weekly Basal Insulin Icodec

Aims

To investigate glucose levels and hypoglycaemia risk during exercise or fasting in adults with type 2 diabetes (T2D) treated with once‐weekly basal insulin icodec.

Materials and Methods

Thirty basal insulin‐treated, physically active individuals with T2D (18–75 years, glycated haemoglobin ≤ 75 mmol/mol, peak oxygen uptake > 20 mL/kg/min) received once‐weekly icodec for ≥ 7 weeks targeting pre‐breakfast plasma glucose (PG) of 4.4–7.2 mmol/L. The final three weeks at icodec steady state comprised a reference week (no additional intervention), an exercise week (40 min cycling [60% peak oxygen uptake] 43 h post‐dose) and a fasting week (18 h fasting 26 h post‐dose). PG was measured at prespecified time points related to exercise and fasting. If PG < 5.0 mmol/L before exercise, or < 4.0 mmol/L between exercise onset and 140 min post‐exercise or during fasting, oral carbohydrate (exercise) or intravenous glucose (fasting) was given. Blinded continuous glucose monitoring (CGM) data were collected throughout.

Results

Mean ± standard deviation CGM‐based time below range < 3.0 mmol/L was 0.3% ± 1.1% during 24 h from exercise onset, 0.2% ± 0.8% during 18 h fasting and 0.0% ± 0.0% during the corresponding reference period. No clinically significant or severe hypoglycaemia was reported. Oral carbohydrate was given to 1, 0 and 3 participants pre‐, during and post‐exercise. Intravenous glucose was given to 15 participants (50%) during fasting (earliest at 10.6 h after start of fasting).

Conclusions

The current results reinforce the safety profile of once‐weekly basal insulin icodec and provide guidance on glycaemic management during exercise or fasting in people with T2D treated with icodec.

Trial Registration: NCT06288412