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1. Once weekly efsitora demonstrated non-inferiority compared with degludec with regards to change in HbA1c.

2. Patients in the efsitora group reported greater hypoglycemic events than those assigned to once daily degludec.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Insulin efsitora alfa is a weekly basal insulin that may be more convenient than current daily insulin regimens. Insulin degludec is an established daily insulin treatment, and comparisons between these options are crucial to understanding the efficacy and safety of efsitora. This randomized controlled trial aimed to evaluate whether once-weekly efsitora is as effective as daily degludec in controlling blood glucose levels in adults with type 1 diabetes. The primary outcome was mean change in HbA1c from baseline to week 26, while a key secondary outcome was the incidence of hypoglycemic events. According to study results, efsitora was non-inferior to degludec in reducing HbA1c but demonstrated increased rates of hypoglycemia. Although this study was well done, it was limited by a high incidence of hypoglycemia in the efsitora group, which may require further investigation into dosing and optimization strategies.

Click to read the study in The Lancet

Relevant Reading: Insulin Efsitora versus Degludec in Type 2 Diabetes without Previous Insulin Treatment

In-depth [randomized-controlled trial]: Between Aug 12, 2022, and May 7, 2024, 893 patients were assessed for eligibility across 82 centers in 6 countries. Included were patients ≥ 18 years with type 1 diabetes and HbA1c between 7.0-10.0%. Altogether, 692 patients (343 in once weekly efsitora group and 349 in once daily degludec group) were included in the final analysis. The primary outcome of mean change in HbA1c was non-inferior for efsitora compared to degludec (7.88% at baseline to 7.41% at week 26 with efsitora, mean adjusted change [MAC] -0.51% vs. 7.94% at baseline to 7.36% with degludec, MAC -0.56%). The secondary outcome of severe hypoglycemia events was higher in the efsitora group than degludec (14.03 vs. 11.59, rate ratio [RR] 1.21, p=0.016). Findings from this study suggest that efsitora may be effective in reducing HbA1c similar to degludec.

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