IcoSema: once-weekly insulin-semaglutide combination offers convenience and weight loss advantage over basal-bolus insulin | Research

The takeaway

IcoSema, combining once-weekly insulin icodec with semaglutide, provides non-inferior glycemic control to basal-bolus insulin with less hypoglycemia, significant weight reduction, and improved convenience for T2D patients.

One weekly injection replaces multiple daily
IcoSema combines insulin and GLP-1 therapy in a single weekly dose, matching basal-bolus efficacy with weight loss instead of gain

What the researchers found

IcoSema: glycemic efficacy non-inferior to glargine+aspart; similar hypoglycemia risk; significant body weight reduction (vs weight gain with insulin); once-weekly convenience; favorable safety profile.

Why it matters

Complex insulin regimens are a major barrier to diabetes management. Reducing from multiple daily injections to one weekly injection while maintaining control and adding weight loss could dramatically improve treatment adherence and quality of life.

How the study worked

Narrative review of insulin icodec, semaglutide, and IcoSema clinical development and key trials.

What this study cannot tell us

Review article based on registration trials. Long-term real-world data limited. GI side effects from semaglutide component remain a concern. Cost and insurance coverage unknown.

How to read the evidence

Review of phase 3 clinical trial data. Strong evidence for non-inferiority and safety.

When this study was published

Published in 2025.

The bigger picture

IcoSema represents the convergence of two major diabetes drug advances—ultra-long-acting insulin and GLP-1 agonists—into a single weekly injection. This could simplify treatment for millions of patients on complex insulin regimens.

Questions still open

How will IcoSema be priced compared to separate insulin and GLP-1 prescriptions?
Will the fixed ratio suit all patients, or will dose flexibility be needed?
Can IcoSema replace basal-bolus insulin for most T2D patients?

Common questions

What is IcoSema?

IcoSema combines two diabetes medications in one weekly injection: insulin icodec (a once-weekly insulin) and semaglutide (a GLP-1 agonist). Instead of taking multiple daily insulin shots plus a separate GLP-1 injection, patients can use one pen once a week.

Is IcoSema better than regular insulin?

Clinical trials show IcoSema controls blood sugar as well as traditional basal-bolus insulin (which requires multiple daily injections), with similar rates of low blood sugar. The key advantages are once-weekly convenience and weight loss—patients on IcoSema lose weight, while those on traditional insulin gain it.

Read the original research

Evaluating semaglutide + LAI-287 (IcoSema) for the treatment of diabetes mellitus type II.

Expert opinion on pharmacotherapy, 26(1), 1-7

View on PubMed ↗Publisher’s paper ↗

Citation

Siamashvili, Maka; Davis, Stephen N. (2025). Evaluating semaglutide + LAI-287 (IcoSema) for the treatment of diabetes mellitus type II.. Expert opinion on pharmacotherapy, 26(1), 1-7. https://doi.org/10.1080/14656566.2024.2436593