Once-weekly basal insulin analogs improve HbA1c and Time in Range in Type 2 Diabetes with similar hypoglycemia risk

Type 2 Diabetes Mellitus (T2DM) often requires insulin therapy to achieve glycemic control, but daily injections can lead to poor adherence and patient burden. Current daily basal insulin regimens, while effective, are associated with challenges in patient convenience and compliance, potentially impacting long-term outcomes. The development of longer-acting basal insulin analogs aims to address these issues by reducing injection frequency, thereby simplifying treatment and potentially improving adherence without compromising efficacy or safety. This meta-analysis investigates the potential of once-weekly formulations to fill this critical gap.

This systematic review and meta-analysis synthesized data from 14 randomized controlled trials (RCTs), encompassing 8,487 adult subjects diagnosed with Type 2 Diabetes Mellitus. The studies compared the efficacy and safety of once-weekly basal insulin analogs, specifically insulin icodec and insulin efsitora alpha, against daily basal insulin analogs. Primary endpoints included changes in HbA1c and Time in Range (TIR), while safety assessments focused on the incidence of level 2 or 3 hypoglycemia. The meta-analysis employed statistical methods to calculate mean differences (MD) and odds ratios (OR) with 95% confidence intervals for pooled outcomes.

Once-weekly basal insulin analogs demonstrated superior glycemic outcomes compared to daily basal insulin regimens in adults with Type 2 Diabetes. The meta-analysis revealed a statistically significant greater reduction in HbA1c with once-weekly insulin, showing a mean difference (MD) of -0.09% (95% CI -0.15 to -0.03). Furthermore, patients on once-weekly regimens experienced greater improvements in Time in Range (TIR), with an MD of 1.86% (95% CI 0.73 to 2.98). This translated to a higher likelihood of achieving the target HbA1c < 7.0%.