1811-P: Therapeutic Transition to Weekly Basal Insulin Icodec plus Tirzepatide in Type 2 Diabetes: An Early Real-World Experience

Introduction and Objective: Novel once-weekly therapies targeting complementary pathways, such as basal insulin and GLP-1 RA, may simplify management and improve outcomes in type 2 diabetes (T2D). This study aimed to evaluate the short-term effects of icodec plus tirzepatide in a real-world setting. Methods: This retrospective observational study included 21 adults with long-standing T2D initiating icodec in combination with tirzepatide, followed for a mean of 3.0±0.2 months. 4 participants were insulin-naïve, while 17 were previously treated with insulin (5 basal-bolus, 12 basal-plus therapy). The primary endpoint was change in HbA1c from baseline. Secondary endpoints were changes in body weight, BMI, and insulin doses in previously insulin-treated participants, as well as treatment simplification. Continuous variables were expressed as mean ± SEM; T-tests were used, with p<0.05 considered statistically significant. Results: HbA1c decreased significantly at three months (74.6±3.1 to 54.8±2.5 mmol/mol, p<0.001), with 52.4% of patients reaching HbA1c≤53 mmol/mol. Body weight and BMI also declined (weight 87.4±3.8 to 84.9±3.6 kg and BMI 31.7±1.4 to 30.8±1.4 kg/m², p<0.001). Total insulin dose decreased of 67.4±38.1 IU/week in prior insulin users (-26% from baseline), especially in those on basal-bolus regimens (-232±76.8 IU/week; -59% from baseline). Notably, 4 of 5 participants on multiple daily injections discontinued rapid-acting insulin, and 4 of 19 reduced the number of oral glucose-lowering medications. One severe hypoglycemic event occurred in a participant who developed anti-insulin antibodies. Conclusion: Weekly basal insulin icodec combined with tirzepatide improved glycemic control and body weight over three months in adults with T2D. Individuals previously on basal-bolus insulin experienced the greatest insulin dose reduction, with marked de-intensification of therapy. These findings support the combination as a strategy for metabolic optimization and treatment simplification in advanced T2D. Disclosure G. Rossi: None. L. Montefusco: None. I. Pastore: Advisory Panel; Ended; Sanofi. Board Member; Ended; Novo Nordisk. L. Pozzi Canova: None. F. D'Addio: Other - Founder and consultant; Ended; Enthera srl. P. Fiorina: Board Member; Ended; Novo Nordisk, Lilly, AstraZeneca, Boehringer Ingelheim International GmbH.