Can a simplified once-weekly insulin regimen maintain glycemic control without increasing hypoglycemia risk? A post hoc analysis of the phase 3 QWINT-1 randomized trial published in Diabetes, Obesity and Metabolism evaluated baseline characteristics and glycemic outcomes of insulin efsitora alfa-treated participants according to their Week 52 insulin dose.

In this 52-week study, efsitora was initiated at fixed doses (100, 150, 250, and 400 U) and titrated every 4 weeks to achieve a fasting blood glucose target of 80-130 mg/dL. Participants not meeting targets at the highest fixed dose transitioned to flexible dosing. Outcomes were assessed according to the final dose at Week 52.

Participants requiring higher efsitora doses had greater baseline body weight, glycated hemoglobin (HbA1c), and fasting glucose. Across all fixed-dose groups, mean HbA1c values were <7.0% at Week 52. Most participants (76%) remained on fixed dosing, with the final dose established by Week 16. Rates of combined Level 2 and 3 hypoglycemia were <0.5 events/year within 4-week periods after fixed-dose increases.

Overall, a fixed-dose titration approach was associated with glycemic control and low hypoglycemia rates.