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.