Once Weekly Basal Insulin

Insulin icodec is the first class of long-acting insulin to be administered only once a week. Join host, Jen Moulton, as she discusses the safety and efficacy of insulin icodec with guest, Geoff Wall.

The GameChanger
Insulin icodec is the first of the ultra long-acting insulins with once weekly dosing. Multiple clinical studies have suggested these pharmacokinetics work. A new meta-analysis suggests that insulin icodec is more effective than other basal insulins and at least as safe concerning hypoglycemia.

Jen Moulton, RPh
President + Founder
CEimpact

Geoff Wall, PharmD, BCPS, FCCP, BCGP
Professor of Pharmacy Practice, Drake University
Internal Medicine/Critical Care, UnityPoint Health
 
Reference
Wang P, Zhang Y, Xu W, et al. Efficacy and Safety of Once-Weekly Insulin Regimes on Glycemic Control for Type 2 Diabetes: A Systematic Review and Network Meta-analysis. Diabetol Metab Syndr. 2024 Jan 3;16(1):3. doi: 10.1186/s13098-023-01240-5. PMID: 38172995; PMCID: PMC10763463.

https://dmsjournal.biomedcentral.com/articles/10.1186/s13098-023-01240-5#Sec19

Pharmacist Members, REDEEM YOUR CPE HERE!
 
Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)


CPE Information
 
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Explain the chemical and structural changes that make icodec different from other basal insulins
2. Discuss the results of the meta-analysis about insulin icodec

0.05 CEU/0.5 Hr
UAN: 0107-0000-24-043-H01-P
Initial release date: 1/29/2024
Expiration date: 1/29/2025
Additional CPE details can be found here.

Follow CEimpact on Social Media:
LinkedIn
Instagram

Transcript

Speaker 1: 0:08

Welcome to the Game Changers podcast, where we have clinical conversations that impact your pharmacy practice. Let's listen in as our team discusses this week's clinical practice game changer hey, ce plan members from CE Impact. This is Game Changers. I'm Jen Moulton and this week we're exploring, once weekly, basal insulin in patients with diabetes. Before we get into it today, I just want to call out that we are pivoting a little bit for today's podcast, and I have the distinct pleasure of talking with my colleague, jeff Wall, who you all obviously know and love.

Speaker 1: 0:40

We've been doing this podcast for over three years now and we hear from so many of you about how appreciative you are for the weekly clinical deep dives and the ability to stay up to date on the most important clinical topics in a quick and easy format. Plus, getting CE is always an added bonus. So I'd like to just take a minute to thank you, jeff, for all you do for the podcast and for keeping me personally on my toes by digging into these cutting edge updates so I don't have to. As a pharmacist, I really appreciate the time that you saved me by doing the heavy lifting and telling me the important aspects of what I need to know. So I just want to take a minute to say thank you.

Speaker 2: 1:20

Thank you, I appreciate it. Yeah, jen had come to me several years ago about the idea of doing a podcast. I'd never done one. I did have some professional radio experience about 16 lifetimes ago and I think that's served me okay in this.

Speaker 2: 1:37

I do want to tell our longtime listeners that we're changing the format a little bit, but the quality, I hope, and the immediacy when a new study comes out, a new guideline comes out that really is going to affect people at the bedside, that we were able to dive right into, that's not going to change. We're going to present things a little bit differently but I hope that the expertise and the practicalities of new drugs and new studies, new guidelines, will be of the same level that you've come to be used to and the many people who have contacted me saying they appreciate it. So don't think that those things are going to change. In fact, we're doing some of these changes for the better, really, and I think we're going to get more guests on board we're going to do a whole bunch of stuff and again, hopefully we'll remain the Pharmacotherapy Podcast of choice for you.

Speaker 1: 2:31

Absolutely. I am obviously very biased, but this is my favorite way to get CE. I really appreciate it, Jeff. So let's get into today's topic of once weekly basal insulin. Now, obviously, we could limit insulin injections for patients with diabetes to once a week. That would be a huge improvement for quality of life. But, Jeff, tell me why you think this is an important discussion right now.

Speaker 2: 2:54

There's a couple of reasons, one and again shameless plug. I know next week we are doing a complete ADA guideline update and so I kind of felt like and I think Jen felt like this would be a good lead into that. But the bottom line is that we have two of these. They're going to be competing for the market.

Speaker 2: 3:12

The one we're going to talk about, iodec, is probably going to be on the market late this spring and the fact that it is a completely different way to give insulin with this I mean it is once a week and that's how it was done in the studies. I think it has the ability to really kind of change up how we deal with using insulin and we'll kind of dive into that a little bit more. But I think a lot of the other quote unquote, so termed long acting insulin was like the glue tech we were told oh, it's 36 hour, 48 hour. In the end almost everybody on that drug is on it daily. But this is a study where they truly gave the drug once a week and we'll talk about what they found in the site we're reviewing.

Speaker 1: 3:55

Awesome. Well, I will let you, as the expert, get into it. Thank, you.

Speaker 2: 4:00

I'll send it over to you. Yeah, we'll do so again. We're going to kind of lead into the 2024 ADA guideline updates coming up next week. Certainly anyone who practices with diabetic patients knows that the whole landscape of treatment of diabetes has gone completely on its head in the last 10 years. I don't think my younger me, at 10 years, would have realized how powerful drugs like STL2 drugs and certainly the GOP drugs have really just completely and utterly changed the landscape of type 2 diabetes. It's worth noting that in 2010, 2011, we were still putting in and we still have patients on this, but we were still putting a lot of people on the form in ancillifaniaries. That was kind of the first treatments of choice, and it's just, yeah, it's amazing to me how the landscape has really changed.

Speaker 2: 4:51

Insulin, of course, is used in many type 2 diabetic patients as their disease progresses and they start to make less and less of their own insulin, and so I'm not sure insulin is ever going to completely go away for type 2 diabetes, but it's still going to be an important therapy. But, as we all know, it has inherent risks to it. It certainly is more likely to cause hypoglycemia than just to buy anything except the savanearyas. We know that cost is a huge issue, though I think, thankfully, we're starting to see some relief legislatively in that area, for which I think everybody's grateful. And then the other thing that we always deal with in a clinical situation is that weight gain is actually very common when people start insulin, and so, especially with type 2 diabetics, the exact last thing we want to do is going to happen, and so there's actually several studies now looking at the combination of insulin and semi-glutide. The evidence for that is actually very strong If they find dramatic drops in hemoglobin A1C and even a net weight loss. So that's kind of interesting as well.

Speaker 2: 5:52

But getting back to what we're talking about here again, I remember when glarging first came out, and I think for people who are too young to remember, glarging really completely changed how we treated diabetes, and it's hard to underestimate or under emphasize that, because before then it was very common to give NPH insulin two or three times a day, three or four times of bolus insulin with foods, and people were checking their blood sugars five times a day, all this other stuff. It was complex, it was associated with a lot of hypoglycemia, and then glarging came on the market, which was, and still is, in my opinion, the best drug that mimics what the body does for basal insulin release and a lot of that stuff just kind of went away and so they have really become the gold standard over the last 15 years for the treatment of type 1 diabetes and in late stage type 2 diabetes. But they are daily injections and I think I always tell my students that I think a lot of the other insulins that have come out to this date have really not significantly improved on glarging and the way it works. But we now may have to have a change to that, and so insulin Icodec is one of two of these once weekly insulins that's in late phase to the clinical development. Again, the studies have largely been done. I believe they're going to do their NDA review, I think next month, so it actually may become available again probably late spring if everything goes OK.

Speaker 2: 7:21

Why does Icodec have a unbelievably long half life? It's because all insulins they've done some amino acid substitutions and kind of switch things around a little bit on the amino acid chain and that changes the kinetics of the drug. In this case they actually added something. They actually added a fatty acid chain to the insulin amino acid chain that allows the molecule to bind reversibly to albumin and that dramatically dramatically prolongs the half life to 196 hours, about seven days again. And because it's a very long half life drug, it does take a few weeks to get to steady state. So, even though this is another recombinant insulin that they've made some adjustments on, this is unique in that they've added a fatty acid chain which allows it to be bound to albumin. A good question to ask is in patients who are hypoalbuminemic, will you have a more sensitive response to that? I am unaware that that has been studied. I looked around for that in the prep for this, but I have not seen that. So that'll be interesting to see if more data comes out on that.

Speaker 2: 8:23

So there's been a number of studies that have looked at both of these long-acting insulins. Again, we're going to focus mostly on Icodec here. The clinical trial series that got everyone kind of interested in Icodec was the Onward series of studies, which, like all diabetic studies, they usually do a series of five or six studies, some short-term, some long-term, some with net formants, some without. I mean, you can go on and on and on. But the Onward set of studies are the studies that have really looked at the use of Icodec in this once weekly fashion. With those kind of studies some long, some short, some of the different comparators, it was inevitable that someone would do a meta-analysis about that, and that's actually what we're going to take a look today about. So there was just recently, in the last three weeks, a large meta-analysis that combined the evidence of the onward series of studies with actually the, the series of studies with the other long-acting insulin, once weakly insulin that's on the market as well, and so kind of bringing all that data together to see what they can find.

Speaker 2: 9:27

This again was a pretty much standard meta-analysis. It did follow the registry that most meta-analysis are supposed to be put in called the Prosper Registry, and this is done because it makes sure there's a standard way of collecting and reviewing the data in a meta-analysis and allows them to follow kind of a standardized approach to pulling studies, reading studies and then adding it into the model for the meta-analysis. They basically wanted only randomized control trials, so they basically only included published randomized control trials. They did not look at retrospective studies, they did not look at anything else basically. So really you know they say that if you have it, you have a meta-analysis of well-done randomized control trials, that it even beats RCTs as a way to assess evidence.

Speaker 2: 10:16

That's always been a controversial notion that I'm not going to get on that fence about. But in this case again they pulled all randomized control trials with both the long-acting ones, weakly insulins. That again the population that they looked at in all these studies, as you might imagine, had very similar inclusion-exclusion criteria. So I had to be over age 18. They had to be diagnosed with type 2 diabetes and I specifically was glad to see this meta-analysis done because it did focus on type 2 diabetes. Certainly, patients with type 1 diabetes are all on insulin, of course, but I think trying to mix those with patients with type 2 diabetes would make the perpetration of such a meta-analysis extremely difficult. So I was glad to see that we're really only focusing on these once-weekly insulins in patients with type 2 diabetes.

Speaker 2: 11:02

Again, they looked at studies that looked at insulin icodec, and then the other insulin is alpha-stora, insulin alpha. I think in the next 10 years that drugs are going to be so unbelievably complex to say that we're just going to kind of, you know, have AI, you know, basically repeat the words to us because we're not going to be able to actually pronounce them anymore. But anyway, insulin epsidora, also insulin icodec, which again, is what the one that's almost certainly going to get on the market first and the one I really wanted to focus on. Basically, they did not limit type dose duration of the study. They didn't do any of that other stuff. They did assess other treatment groups, whether they were placebo whether they were, you know, against insulin-glargine etc.

Speaker 2: 11:47

Etc. And they did want to focus on active control studies. So almost all of the studies had either one staley insulin, including insulin-glargine, insulin-deglutech, as their comparator arms. So basically we've collected a whole bunch of studies. They're all randomized control studies, they're all type 2 diabetics and almost all have a direct active comparator arm.

Speaker 2: 12:09

The primary outcome in this meta-analysis was patients who developed an A1c below 7%, or a proportion of patients who basically got their hemoglobin A1c at goal. One thing I'm very concerned about, and I suspect most people out there are really concerned about, is safety outcomes. Right, you know, I'm going to give you a dose of once weekly insulin and then tomorrow you decide to go on a fast, for whatever reason, or tomorrow you decide that you're going to start training for a marathon or whatever reason, and so I think I don't think anybody really is concerned about efficacy with these drugs, but safety, I think I think is a big deal. And so they had important secondary safety outcomes, including a variety of hypoglycemic levels. They looked at just the number of alerts, the patients, blood glucose monitoring and the vast majority of these patients studies were given a CGM, so they had continuous blood glucose monitoring. They also looked at clinically significant hypoglycemia and severe hypoglycemia, which actually required some sort of external use, not just, you know, taking juice or something, but had actually be seen by somebody to assess. Basically, as I mentioned, they included randomized control studies. They did not include crossover studies.

Speaker 2: 13:21

They then, when they had this entire potential pool of studies, they had two independent reviewers and this is always done in a meta analysis. They did do a risk of bias tool again very, very common to take a look and see which of the studies had either the potential for high bias, low bias or just some concerns and this. And they also graded the meta analysis and the results based on the grade methodology, which is, again, the standard way that almost everybody does meta analysis. At this point, the stats in meta analyses are always complex and I won't, you know, turn, you know, basically put people to sleep, especially who happen to be on a freeway right now. Suffice it to say that it was a complex set of statistics.

Speaker 2: 14:02

I did a review on it. It made sense to me. They did do a Markov model where they did multiple, multiple iterations, you know, of the meta analysis to make sure that the data was basically the same no matter what, and that's again that's not uncommon in meta-analytic techniques and so everything else needed to be to be reasonable to me. So they started off with, you know, looking at PubMed and Mbase and all that other stuff, they ended up with with about 275 studies and after they excluded everything and and all that other stuff, they ended up with seven studies for a review on the meta analysis. They did do some depth of looking at these studies. All of them were once weekly ICA deck, but four of the studies did allow non-insulin glucose lowering agents, including SGL2 drugs and GLP drugs and metformin. So they, you know, so four of the studies were allowed to do that. Two of the studies were not. They were, to straight up, once weekly insulin ICA deck. They only had one study and again, I think that's why ICA deck is going to hit the market first. They only had one study that met this criteria for the once weekly estadora long acting insulin. So again, that's why I didn't really wanna focus on that.

Speaker 2: 15:16

Comparator arms again, they managed to pull studies. All seven studies had one comparator arm, almost all of them. Actually, five of the seven studies used a glargin and then two of the seven studies used a diglutech. They did not really go into detail about bolus insulin amounts so I mean I believe you know bolus insulins with food was kind of left to the discretion of the studies themselves.

Speaker 2: 15:41

I pulled a couple of these studies and they actually did not allow patients to take anything but basal insulin. So some of that was at the discretion of the investigators but I suspect, given what they were trying to figure out here, they did not allow routine bolus insulin injections with food. However, they did allow card counting and adjustments from there. So a duration of the studies went from anywhere from 16 to 78 weeks and so again, you know studies that even go 18 months compared to pretty short term studies. That kind of combine this metanalysis. They had a total of about 3000 patients, so not a bad size for a metanalysis. Mean age in the study was about 60 years old, a little bit plus or minus there, and then bought a half and half males. I mean it slightly skewed a little bit more male, around 60%, but again, for all intents and purposes, about half and half males. What did they find in this and what were the results and how can we apply them to this patient population? We will talk about that after we're from our sponsor, ce Impact.

Speaker 1: 16:47

Are you a pharmacist by design? Since we hold a vital position on the healthcare team, it is our responsibility to advance our knowledge and skills so we can provide the best possible care to our patients. Being a pharmacist by design means striving to be the best version of ourselves, not just as professionals, but as individuals dedicated to improving patient outcomes. Learn more about pharmacists by design at ceimpactcom. Join us and begin your journey to being the best version of your pharmacist self.

Speaker 2: 17:18

So we were back talking about insulin Icodec and talking about a metanalysis that kind of tried to bring together the information of looking at long acting once weekly insulins on their efficacy and safety. As I mentioned, this metanalysis contained seven studies and what they basically found. When they took a look at the proportion of patients who reached the hemoglobin A1C, they actually noted that once weekly Icodec was actually more effective, not only to the comparison once weekly insulin with a relative risk of 1.5. So basically you were about 60% more likely to reach a hemoglobin A1C goal of less than seven with insulin Icodec compared to once weekly insulin F-sidora. But more importantly, they found that it was also more effective than both Deglutec and Glorgin. At the proportions of patients who got to a hemoglobin A1C of less than seven, the Deglutec results were much more strong, with an effect size of 1.43. So again, 43% more likely to reach that goal, whereas the Glorgin actually, interestingly, was less at only 15% or a relative risk of 1.15. It just barely made statistical significance as well, which I thought was kind of interesting. But bottom line was that most of these studies were non-imperiority studies that they reviewed and putting all the data together they found that in fact once weekly Icodec was more effective at proportion of patients reaching a hemoglobin A1C of less than 7%. So it's effective, terrific.

Speaker 2: 18:53

Well, what about safety outcomes? And again, this is where I have to admit I'm a little bit nervous about that. So I was fairly surprised to read that, in fact, when they looked at the secondary safety outcomes, that once weekly insulin Icodec was actually associated with a lower incidence of severe hypoglycemia that required outside intervention, compared to once daily to Glutec. And the numbers were actually fairly small because, I mean again, severe hypoglycemia rates are small across the board, but what there was is statistically significant decreased risk. And then, but they did not find any difference in decreases of hypoglycemia rates between the other once weekly insulin and glargin. And in fact the glargin, which is the one that that we would usually, to compare this to the 95% confidence interval, was 0.03 to 4.8. So very wide confidence interval, but still statistically no difference.

Speaker 2: 19:46

Now again, I would, I would have a bit of caution with that. You know, overall severe hypoglycemic rates are rare, really across all insulin studies period. Of course, with the, with the advent of continuous blood glucose monitors, those numbers have plummeted even more. So I'm not, you know, I'm not going to walk away from this meta analysis going oh, they're just as safe, if not safer. But I think there's certainly no signal in this meta analysis that incidences of either mild to severe hypoglycemia is is more frequent with one's daily icodec compared to either the other once weekly regimen or the the daily regimens that we use use pretty commonly. Here they found other side effects, pretty similar with new insulins. There's always some question about injection reactions and again, because this is quite a bit different from some of the other recombinant insulins on the market, I think there was some concern about that, but they actually did not find a statistically significant difference in injection site reactions compared to insulin, bargene insulin, to glue tech stuff like that.

Speaker 2: 20:48

So their conclusions in the study was that, based on their meta meta analysis, that insulin icodec is at least, if not more, effective at getting people to a hemoglobin a1c of less than seven. This is true when they broke up the data whether they were receiving insulin by themselves or, more commonly, on other medications to also lower their blood sugar. So it seemed to be more effective than both large gene and the glue tech and getting people to a hemoglobin a1c of less than seven percent. So at least, if not more effective based on this meta analysis. And then safety, I think a more conservative way to approach those results is there was no signal for increased severe hypoglycemia of one's daily icodec compared to insulin center already on the market. It's worth noticing that when I was going through the study that and pulled some of the original stuff that a lot of these are, several of these studies had patients who entered the study who were already on insulin and they were already on a long-acting insulin and a twice or three times a day bolus insulin with meals. And in the studies those couple of studies that I read they actually did not allow a scheduled bolus insulin. They were allowed again to card count and give themselves some adjustment based on carbs, but routine boluses were not done.

Speaker 2: 22:10

I was really hoping this meta analysis would, would carve those patients out, because that would really change things right if people could literally take once weekly icodec and pretty much just, you know, measure their sugars and if they get super high give them a little bit, but not have to routinely take bolus insulin with meals again. That would be. That would be pretty incredible, probably more so with type one diabetes than type two diabetes, but very interesting to see. So I kind of wish they had done that. They may not have had the numbers to do that, but but that's something I thought would have been interesting to see.

Speaker 2: 22:41

They note there themselves there were some limitations. There was a wide range of duration again, from 16 to 78 weeks that the titration algorithms in the different studies were different. So you know, starting at x dose, then going up by so many units, was different between the different studies. Again, they noted that that while they were randomized control trials, almost none of these were blinded. They'd be. You know, I suppose you could do that. I suppose you could blind somebody by giving them, you know dummy once weekly insulin and then in one group who were getting large gene. Or you could have someone get the icodec and get dummy once daily large gene.

Speaker 2: 23:20

But that seems to be pretty difficult so it does surprise me these would be open label studies. I you know I get that that might be a potential strike, but again I don't know how you pull these kind of studies out. So that that's kind of interesting. And again they know that that themselves, that that safety considerations we still have to have to be worried about or concerned about just because of the low numbers and all these studies. I think you know phase four type studies will probably be done. That will probably try and answer that kind of question what's it for all? So for my analysis this looked okay.

Speaker 2: 23:53

One of the things I really surprised me is that the meta analysis report did not look at heterogeneity at all and that's pretty unusual. Almost all meta analyses nowadays will give you a heterogeneity statistic. Usually the i-squared statistic is what is used and that helps us get an idea of the differences of the studies. And and it doesn't necessarily mean that the meta analysis is bad, but you know a meta analysis is really kind of garbage in, garbage out and if you have wildly different studies with wildly different outcomes, with wildly different populations, it is more difficult, I think to to pull that data together and meta analytic technique to find out what was going on. They didn't report heterogeneity at all, which again really surprised me. However, I will say that that, considering they used all randomized control studies, most of them with an active control, almost all of them with with kind of the same inclusion exclusion criteria, if I were to guess the heterogeneity would be a whoa.

Speaker 2: 24:48

But again, that's a guess on my part, because they really did not mention that.

Speaker 1: 24:54

So what are we going?

Speaker 2: 24:54

to do with this? That's a good question. Like I said, it's supposed to be available late spring, early summer, 2024. I shudder to think what the cost of this is going to be. You know, again, people may go, hey, this is great, and instead of having to inject myself every day, it's every week, so it's much less. So I'll bet you it's cheaper. I will be very surprised that it's cheaper Because that's just not how things go anymore.

Speaker 2: 25:16

So it'll be interesting to see how we position this with type two diabetes, especially with the advent of some of the insulin GOP drugs that are coming out on the market which theoretically should be as or more effective than regular insulin, as well as blunting significantly the weight gain associated with it.

Speaker 2: 25:34

How is all that going to get positioned in type one diabetes, which we didn't go here? I think it's going to be really interesting to see where that rolls as well. So my kind of thought was, you know, again, based on costs and training, I think that, in particular, patients who are not very adherent, once daily insulin and maybe the first candidate you want to use from this perhaps I'm thinking in a fantasy land, but you know, is there a world where a patient who's on. This goes into their pharmacy and basically you know they get their blood sugar checked and it's almost like direct observed therapy for TB, where they get their once week shot and they kind of wave at them and they kind of you know, head out. Hopefully you don't buy a whole bunch of Cheetos and diet or regular Mountain Dew and go to the front and ring that up, but I'm sure that probably wouldn't happen at some point.

Speaker 2: 26:27

So, and again, you know, but I think that if I had to pick a group of patients that I think might be really good for this, it would be patients who are just straight to be their needophobic or just, you know, are basically not adherent. That's kind of what I take away from this.

Speaker 2: 26:41

So Jen, I don't know, you know, if this seems interesting, the promise is certainly there. I admit I'm a bit nihilistic about this, if for no other reason that you know, since the advent of Glargine we've had about, you know, 10 different new insulins come out and, in all really purposes, they've not really shown any real demonstrable clinical benefit over good old fashioned Glargine. And so will this drug really hold true to its promise of, you know, once weekly use, more effectiveness and as safe? I think only time will tell.

Speaker 1: 27:14

Well, thanks, jeff. Yeah, it's super interesting. I loved your discussion about the safety. You know, and I think CGMs have, you know, paved the way for all of this. You know innovative technology and you know really giving you real time data, so I think that's great. It feels like and I don't know if you agree with this, but it feels like for a long time we didn't have anything in this space for diabetes and nothing was new, and now it feels like it's kind of ramping up. Do you? I mean, do you feel like that?

Speaker 2: 27:40

Oh yeah, no, I mean you know, I think that that you know we went. What I mean, you know, met Foreman came out in the early 1980s and that's even before my time. I know it's hard to believe, but you know it really you know that was, I think, the first time that really had turned the treatment of diabetes on its head. You know, and you know, because it not only was safe in most cases, it did a good job of Lording Hemoglobin C, but there was some evidence of cardiovascular benefit which no other drug had ever had before. And then you kind of went about 30, you know 25 years of not a whole lot going on. Glarging came out in the early 2000s, let's you know. So you had kind of a 15 year kind of kind of difference there. And then we had a bit of a wall too.

Speaker 2: 28:24

And now again everything's exploding with, you know, glp one drugs, sgl two drugs, and then the combinations of all these as well as you know the triple G drugs which are almost certainly going to be on the market, and you know, in the next couple of years the combined there's also a combined SGL T one and SGL two drug on the market that that will be on the market, that they're studying. So, yeah, you know we've, we're, we're attacking diabetes in ways we never thought and, of course, the technology is keeping up, which, again, I think had lagged behind. Certainly, you know how long will it be before we have, you know, ai ran pumps which are basically connected to patients with type one diabetes. They, you know, real time monitor every 10 minutes and make you know micro amount adjustments to you to a two basal insulin. I mean at that point, for type one diabetes, for all sense of purposes. Are you cured? You know? So it'll be interesting to see, yep.

Speaker 1: 29:17

I agree, yeah, yeah, absolutely yeah, it'll be. It'll be super interesting couple of years, so just stay on top of it.

Speaker 2: 29:24

Yeah, as always.

Speaker 1: 29:26

Jeff, thank you so much for joining us. I so appreciate you diving into this and pulling out the most important pieces. So I just always learned so much. So thank you.

Speaker 2: 29:37

Thank you.

Speaker 1: 29:38

And thank you to everyone for joining us every week. If you're a CMPAC plan member, be sure to claim your credit for this episode by logging in at CMPACcom and we will talk to everyone next week. Thanks and have a great week, jen, here. Be sure to check out our education at CMPACcom. You'll find it to be your one-stop shop for all the CE resources you need. Become a pharmacist by design member today to access it all for free, including CE for this podcast. Thanks for listening. We'll talk to you next week on Game Changers Clinical Conversations.