N Engl J Med

ADA 2025: Once-weekly insulin efsitora rivals daily glargine in glycemic control

June 27, 2025

Efsitora offered a simplified, once-weekly alternative to daily basal insulin with comparable glycemic control, fewer hypoglycemic events, and reduced titration burden, according to data from QWINT-1, and could potentially improve adherence and patient satisfaction in insulin-naïve T2DM.

Study details: The phase 3 QWINT-1 trial (NCT05662332) randomized 795 adults with T2DM and no prior insulin use to receive either once-weekly insulin efsitora alfa (efsitora) or once-daily insulin glargine U100. Efsitora was administered at fixed doses (100–400 U/week) with adjustments every 4 weeks, while glargine was titrated weekly or more frequently to achieve fasting glucose targets of 80–130 mg/dL. The primary endpoint was change in HbA1c at 52 weeks.

Results: At 52 weeks, HbA1c dropped similarly in both groups (−1.19% with efsitora vs. −1.16% with glargine), confirming noninferiority (difference: −0.03%; 95% confidence interval [CI] −0.18 to 0.12; P = 0.68). Efsitora had a 43% lower rate of significant or severe hypoglycemia (0.50 vs. 0.88 events/participant-year) and required fewer dose adjustments (median 2 vs. 8) and a lower weekly insulin dose (289.1 U vs. 332.8 U).

Source:

Rosenstock J, et al; QWINT-1 trial investigators. (2025, June 22). N Engl J Med. Weekly Fixed-Dose Insulin Efsitora in Type 2 Diabetes without Previous Insulin Therapy. https://pubmed.ncbi.nlm.nih.gov/40548694/