Once-weekly insulin icodec in type 1 diabetes: Are we ready for children?

During my fellowship training in pediatric endocrinology, my understanding of the ambulatory care of type 1 diabetes (T1D) evolved considerably.I had initially viewed the basal-bolus regimen and a so-called prescribed diabetic diet as the major pillars of management.In the diabetes clinic, however, I learned that successful care extends far beyond insulin prescription and diet adjustments-asking about insulin doses taken during the school hours, identifying hypoglycemia and hyperglycemia patterns, checking injection technique, understanding social challenges, and helping families obtain insulin and glucose-monitoring supplies.In the developing world, clinicians are still struggling to educate parents/caregivers and children on the importance of adhering to a basal-bolus insulin regimen, regular blood glucose level monitoring, emphasis on the use of continuous glucose monitoring (CGM), and the need to administer bolus insulin for meals consumed during school hours.Attempts to reduce the immediate burden and cost of glucose checks and insulin injections may ultimately come at the expense of suboptimal glycemic control and its resultant long-term complications.In this background, one of the major developments in diabetes care this year has drawn my attention-the US Food and Drug Administration (FDA) approval of insulin icodec (Awiqli), the first once-weekly basal insulin, on March 26, 2026, for use in adults with type 2 diabetes mellitus (T2D).For a pediatric endocrinologist, this raises an intriguing question: "Could once-weekly basal insulin someday ease the treatment burden for children and adolescents with T1D?"