Introduction & Objective: In ONWARDS 5, a 52-week, phase 3a trial, participants in the insulin icodec (icodec) group used a dosing guide app to assist titration. This post hoc analysis assessed adherence to app-based dose guidance and its association with prebreakfast self-measured blood glucose (SMBG).

Methods: The app provided weekly algorithm-driven icodec dose guidance based on prebreakfast SMBG. Regardless, investigators could suggest manual dose changes. Estimated mean prebreakfast SMBG over time was compared across app-based guidance adherence subgroups (Figure).

Results: On average 5.0% of administered icodec doses differed from app guidance (dose change by participant). Of 541 participants assessed, 56.7% had ≥1 manual dose change during the trial; most changes (82%) were increases to the dose recommended by the app. Estimated mean prebreakfast SMBG improved from baseline irrespective of adherence to app guidance. Medium/high adherence subgroups had statistically significantly lower mean prebreakfast SMBG (p<0.0001) with earlier achievement of target level (80-130 mg/dL) than the low adherence subgroup (Figure).

Conclusion: Most administered icodec doses were adherent with app guidance; medium/high vs low adherence to app guidance was associated with improved estimated SMBG. The findings support the use of dose guidance apps to assist real-world insulin titration.

graphic
View largeDownload slide
Disclosure

H.S. Bajaj: Research Support; Abbott, Amgen Inc., Anji Pharmaceuticals, Boehringer-Ingelheim, Eli Lilly and Company, Novartis Pharmaceuticals Corporation, Novo Nordisk, Pfizer Inc. A.M. Donatsky: Employee; Novo Nordisk A/S. S. Engberg: Employee; Novo Nordisk A/S. Stock/Shareholder; Novo Nordisk A/S. J.H.J. Martiny: Employee; Novo Nordisk A/S. Stock/Shareholder; Novo Nordisk A/S. A.G. Vianna: Board Member; Abbott, Lilly Diabetes, Novo Nordisk, Medtronic. Speaker's Bureau; AstraZeneca, Novo Nordisk. Research Support; Novo Nordisk, Lilly Diabetes. Speaker's Bureau; Lilly Diabetes. Research Support; Servier Laboratories. I. Lingvay: Consultant; Altimmune, Astra Zeneca, Bayer, Biomea, Boehringer-Ingelheim, Carmot, Cytoki Pharma, Eli Lilly, Intercept, Janssen/J&J, Mannkind, Mediflix, Merck, Metsera, Novo Nordisk, Pharmaventures, Pfizer, Sanofi. Research Support; NovoNordisk, Sanofi, Mylan, Boehringer-Ingelheim. Consultant; TERNS Pharma, The Comm Group, Valeritas, WebMD, and Zealand Pharma.

Funding

Novo Nordisk A/S

© 2024 by the American Diabetes Association
2024
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.