A Weekly Insulin Kept Pace With Daily Injections in Type 2 Diabetes

CATEGORY: METABOLIC & BLOOD SUGAR

A year of daily background insulin means 365 injections. A weekly version means 52. Across 795 adults with type 2 diabetes, randomly assigned to one or the other, the weekly shot held blood sugar just as steady over a full year.¹ Average A1C, a blood test that reflects average blood sugar over about three months, fell 1.19 percentage points on the weekly insulin and 1.16 on daily insulin glargine. Episodes of low blood sugar ran 43% lower on the weekly drug: 0.50 against 0.88 per person per year.

Four Set Doses Instead of Constant Fine-Tuning

The trial, called QWINT-1, enrolled adults whose blood sugar stayed too high on pills alone. None had used insulin before. Most were taking metformin. A randomization list, not the patient and not the prescriber, decided who started efsitora, a long-acting insulin built for once-weekly injection, and who started insulin glargine, a standard once-daily insulin. Both groups were followed for 52 weeks. The dosing is what was new here. Rather than the usual routine of frequent individual adjustments, the weekly insulin came in four set dose levels, stepped up at most every four weeks from simple blood sugar readings. Over the year the weekly group needed a median of two dose changes. The daily group, adjusted the conventional way, needed eight.

The Hazard That Keeps People Off Insulin

Low blood sugar, or hypoglycemia, brings shakiness, sweating, confusion and, in severe cases, loss of consciousness. It is the main danger of insulin treatment and a common reason people put off starting. Here the weekly insulin produced 43% fewer clinically significant episodes than the daily one, with severe events rare in either group. Blood sugar control came out statistically equivalent. The trial had set a strict margin in advance for calling the weekly insulin no worse, and the result cleared it with room to spare. Both groups finished the year with an average A1C near 7%.

Efsitora Is Still Waiting on Regulators

QWINT-1 is one of several trials pointing the same way. An earlier 52-week randomized trial, QWINT-2, matched the same weekly insulin against degludec, another modern daily insulin, in adults with type 2 diabetes, including many who were also taking GLP-1 medicines.² The findings cover adults with type 2 diabetes starting basal insulin, the slow, steady background supply that works around the clock. The trial was open-label, so participants knew which insulin they were getting. Efsitora remains under regulatory review rather than on pharmacy shelves. How fixed dosing behaves outside a trial’s structured check-ins is the open question.

Key Takeaways

• Once-weekly efsitora at preset doses lowered A1C as much as daily glargine over a full year in 795 adults new to insulin: 1.19 versus 1.16 percentage points.
• Low-blood-sugar episodes were 43% less frequent on the weekly drug, 0.50 against 0.88 per person per year, and the weekly group needed a median of two dose changes against eight.
• The trial was open-label and efsitora is not yet approved; a companion trial, QWINT-2, found the same weekly insulin matched daily degludec.

References

1. Rosenstock J, Bailey T, Connery L, et al. Weekly Fixed-Dose Insulin Efsitora in Type 2 Diabetes without Previous Insulin Therapy. New England Journal of Medicine. 2025; published online June 22, 2025:NEJMoa2502796. link
2. Wysham C, Bajaj HS, Del Prato S, et al. Insulin Efsitora versus Degludec in Type 2 Diabetes without Previous Insulin Treatment. New England Journal of Medicine. 2024; published online September 10, 2024:NEJMoa2403953. link