Reducing injection frequency while maintaining glycemic control is a major goal in type 2 diabetes management. The QWINT-1 study, presented at the European Association for the Study of Diabetes Congress 2025, evaluated a first-of-its-kind fixed-dose titration of once-weekly insulin efsitora alfa compared with once-daily glargine U100 in 975 insulin-naïve adults. 

Efsitora was initiated at 100 units per week, titrated every four weeks to 150, 250, or 400 units to achieve fasting blood glucose targets of 4.4–7.2 mmol/L, with flexible dosing for those exceeding 400 units/week. At week 52, mean HbA1c decreased from 8.20% to 7.05% with efsitora and from 8.28% to 7.08% with glargine, confirming noninferiority (estimated treatment difference −0.03%; 95% CI −0.18 to 0.12%). Insulin doses were lower with efsitora (289 vs 333 units/week), and fewer dose titrations were required (mean 3.5 vs 9.4). Rates of level 2 or 3 hypoglycemia were 43% lower with efsitora (0.50 vs 0.88 events/year; p=0.005). Adverse events were comparable between groups. 

These findings suggest that fixed-dose weekly efsitora provide effective glycemic control with reduced injection burden and hypoglycemia risk compared to traditional daily basal insulin titration.