Once-Weekly Insulin: Type 2 Diabetes Treatment
- CHICAGO - A once-weekly basal insulin achieved similar HbA1c levels compared to once-daily insulins among adults with type 2 diabetes, both in those previously using basal insulin and...
- At the American diabetes Association Scientific Sessions, researchers presented findings from the QWINT-1, QWINT-3, and QWINT-4 trials, which evaluated once-weekly insulin efsitora (Eli Lilly) in three distinct patient...
- Julio Rosenstock, MD, FACE, senior scientific advisor for Velocity Clinical Research, director of Velocity's site at Medical City Dallas, and clinical professor of medicine at the University of...
Discover how a once-weekly insulin shows promise in managing type 2 diabetes. Recent findings from the QWINT trials reveal that efsitora achieved comparable HbA1c levels compared to once-daily insulins for adults with type 2 diabetes, irrespective of prior insulin use. The study indicates this new form of insulin can possibly simplify the treatment for improved glucose control, with no increased risk of hypoglycemia, according to key research highlights. News Directory 3 provides a extensive overview of the clinical trial results. Delve into the details of the QWINT-1 and QWINT-3 trials to understand the potential benefits of insulin efsitora offering notable advancements in the fight against diabetes. What’s next for this innovative approach?
Once-Weekly Insulin Efsitora Shows Promise in Type 2 Diabetes Management
Updated June 23, 2024
CHICAGO – A once-weekly basal insulin achieved similar HbA1c levels compared to once-daily insulins among adults with type 2 diabetes, both in those previously using basal insulin and those new to insulin therapy, according to data from the QWINT trials.
At the American diabetes Association Scientific Sessions, researchers presented findings from the QWINT-1, QWINT-3, and QWINT-4 trials, which evaluated once-weekly insulin efsitora (Eli Lilly) in three distinct patient populations. The trials compared insulin efsitora to once-daily insulin glargine in QWINT-1 and QWINT-4, and to once-daily insulin degludec (Novo Nordisk) in QWINT-3. across all three trials,insulin efsitora met the primary endpoint,demonstrating noninferior HbA1c reductions compared to the once-daily insulins,with a noninferiority margin defined as an HbA1c difference of 0.4 percentage points or less.
Julio Rosenstock, MD, FACE, senior scientific advisor for Velocity Clinical Research, director of Velocity’s site at Medical City Dallas, and clinical professor of medicine at the University of Texas Southwestern Medical Center, noted the challenges of titrating once-daily insulin for patients, which can led to nonadherence or delayed treatment initiation. Rosenstock suggested that insulin efsitora could simplify insulin initiation and management.
“We’re very familiar with the single fixed dosing that has been widely used, accepted and increasingly utilized very successfully with [incretin-based] therapies,” Rosenstock said during a press conference. “You can imagine that if we can do the same with weekly insulin, that may become a real game changer.”
QWINT-1
The QWINT-1 trial included 795 adults with type 2 diabetes who were not previously using insulin (49.9% women; mean age, 56.3 years).Participants were randomly assigned (1:1) to receive either once-weekly insulin efsitora or daily 100 U insulin glargine for one year.The insulin efsitora group started at 100 U per week, with dose adjustments to achieve a fasting blood glucose between 80 mg/dL and 130 mg/dL. Participants with glucose levels exceeding 130 mg/dL after reaching a fixed dose of 400 U insulin efsitora transitioned to variable dosing.
the insulin efsitora group experienced an HbA1c decrease from 8.2% at baseline to 7.05% at one year, while the insulin glargine group saw a decline from 8.28% at baseline to 7.08% at one year. The HbA1c decline with insulin efsitora was noninferior to that of glargine (estimated treatment difference, -0.03 percentage points; 95% CI, -0.18 to 0.12; P for noninferiority = .68).
At one year, 57% of the insulin efsitora group and 52% of the insulin glargine group achieved an HbA1c of less than 7%. Mean fasting glucose was 127.7 mg/dL and 126.7 mg/dL, respectively. The insulin efsitora group had a lower mean total weekly insulin dose at one year (289.1 U/week vs. 332.8 U/week).
The insulin efsitora group experienced lower rates of level 2 hypoglycemia (glucose less than 54 mg/dL) or level 3 hypoglycemia (requiring assistance for treatment) compared to the insulin glargine group (estimated RR = 0.57; 95% CI, 0.39-0.84). Forty-one percent of the insulin efsitora group and 33% of the insulin glargine group achieved an HbA1c of less than 7% without experiencing a level 2 or level 3 hypoglycemia event.
Adverse events occurred in 59.9% of the insulin efsitora group and 65.1% of the insulin glargine group. Severe adverse events were reported by 6.5% and 5.3%, respectively.
Rosenstock emphasized the reassuring finding that once-weekly insulin did not lead to higher rates of hypoglycemia compared to a once-daily therapy.
“In terms of the adverse event profile,we didn’t see any signal,nothing to be concerned about,” Rosenstock said.
Rosenstock also noted that 76% of adults in the insulin efsitora group were able to maintain glycemic control on a fixed dose by the end of the trial.
“I think this can substantially facilitate and simplify initiating and escalating insulin therapy, possibly changing the management paradigm in type 2 diabetes,” Rosenstock said.
QWINT-3
QWINT-3 enrolled 986 adults with type 2 diabetes who were using basal insulin and up to three glucose-lowering drugs at baseline without prandial insulin (median age, 62 years; 44% women). the study group was randomly assigned (2:1) to receive either once-weekly insulin efsitora or once-daily insulin degludec for 78 weeks. The primary endpoint was noninferiority in HbA1c between the two groups at 26 weeks.
In the treatment-regimen estimand, HbA1c declined from 7.8% at baseline to 6.99% at 26 weeks for the insulin efsitora group. The insulin degludec group had an HbA1c decline from 7.79% at baseline to 7.08% at 26 weeks. The insulin efsitora group had a 0.09 percentage point greater decline in HbA1c than the insulin degludec group, meeting the study’s 0.4 percentage point noninferiority margin.
At 52 weeks,the insulin efsitora group had a greater HbA1c decrease than the insulin degludec group (estimated treatment difference; -0.19 percentage points, 95% CI, -0.3 to -0.07; P = .0014). The two groups had a similar change in HbA1c at 78 weeks.
Change in FBG was similar at 26 weeks between the two groups. In the 4 weeks before week 26, both groups had a similar time in range as measured by continuous glucose monitoring, with a 62.8% time in range for those assigned insulin efsitora and 61.3% for those assigned insulin degludec.
What’s next
Further research is needed to determine the long-term effects and optimal use of once-weekly insulin efsitora in managing type 2 diabetes.