Optimizing insulin therapy while minimizing hypoglycemia remains a central challenge in type 2 diabetes management. The QWINT-1 study, presented at the European Association for the Study of Diabetes Congress 2025, evaluated fixed-dose titration of weekly insulin efsitora alfa versus daily glargine U100 in 795 insulin-naïve adults. 

Efsitora was initiated at 100 units/week and titrated every four weeks to 150, 250, or 400 units to achieve fasting blood glucose targets of 4.4–7.2 mmol/L. Participants exceeding 400 units/week transitioned to flexible multi-dose pens. Analysis of baseline characteristics revealed that individuals requiring higher efsitora doses had greater weight, body mass index, HbA1c, and fasting glucose, with a higher proportion of males. Most participants (76%) remained on fixed dosing, with a subset transitioning to flexible dosing. 

Across all efsitora doses, HbA1c reductions at week 52 were similar to glargine, ranging from -1.2% to -1.3% (-13.2 to -14.6 mmol/mol). During the initial 16 weeks, the rate of level 2 or 3 hypoglycemia was lower with efsitora versus glargine (0.34 vs 0.69 events/year, p=0.027). Fixed-dose escalation did not increase clinically significant hypoglycemia, supporting the safety and efficacy of weekly efsitora titration in type 2 diabetes management.