Once-weekly insulin efsitora alfa versus once-daily insulin degludec in adults with type 2 diabetes currently treated with basal insulin (QWINT-3): a phase 3, randomised, non-inferiority trial.

Summary

In this 78-week, multicenter, phase 3, treat-to-target non-inferiority RCT, once-weekly efsitora achieved non-inferior glycemic control to daily degludec in adults with type 2 diabetes on basal insulin. Efsitora was well tolerated and offers a marked reduction in injection frequency.

Key Findings

• Once-weekly efsitora was non-inferior to once-daily degludec for HbA1c control over 78 weeks.
• The study supports efsitora as a well-tolerated weekly basal insulin option.
• Injection frequency is substantially reduced with weekly dosing, potentially improving adherence.

Clinical Implications

Efsitora can be considered for adults with T2D requiring basal insulin, especially those struggling with daily injections; real-world studies should assess adherence, quality-of-life, and long‑term safety.

Limitations

• Open-label design may introduce performance and detection bias
• Generalizability limited to adults on basal insulin without prandial insulin

Future Directions

Evaluate real-world effectiveness, adherence, quality-of-life, hypoglycemia profiles, and outcomes in special populations (older adults, CKD, hepatic impairment).