The advent of long-acting basal insulin weekly formulations represents a landmark milestone. While ensuring hypoglycemic efficacy and safety, it significantly reduces the injection burden, providing more treatment options for patients with type 2 diabetes (T2DM).At present, icodec insulin, the world’s first insulin weekly formulation, has been included in China’s medical insurance catalogue, and an increasing number of physicians and patients prefer switching from daily basal insulin formulations to the weekly one.
Icodec insulin has been recommended by several domestic and international guidelines/consensuses for the clinical treatment of T2DM patients.The Expert Guidance Recommendations for the Clinical Application of Icodec Insulin, a Basal Insulin Weekly Formulation, in the Treatment of Type 2 Diabetes issued in 2025 provides important guidance for clinicians to use icodec insulin rationally and standardly.
Icodec insulin has an extended half-life of up to 196 hours. After subcutaneous injection, it is absorbed into the bloodstream and binds strongly and reversibly to albumin, forming an inactive albumin-bound reservoir. It is then slowly and continuously released from the reservoir, exerting a “steady trickle” effect on target organs and tissues.
The favorable safety profile of icodec insulin is closely related to its unique prolonged-action mechanism via the albumin-bound reservoir.Notably, all icodec insulin bound to albumin in the reservoir is inactive; only a small fraction of free drug released into the circulation is pharmacologically active.Therefore, even with a once-weekly dose injection, icodec insulin does not increase the risk of hypoglycemia compared with daily formulations.An initial 1.5‑dose conversion can achieve clinical steady state more rapidly, thereby enabling more stable glycemic control.Both clinical evidence and its mechanism of action support its favorable safety profile.