Efficacy and safety of once-weekly basal insulin analogs versus daily basal insulin analogs in adults with type 2 diabetes: a systematic review and meta-analysis

Recently developed once-weekly basal insulin analogs, including insulin icodec and insulin efsitora alpha (efsitora), aim to improve treatment adherence and patient convenience compared with daily basal insulin. This systematic review and meta-analysis evaluated the efficacy and safety of once-weekly basal insulin analogs compared with daily basal insulin analogs in adults with type 2 diabetes mellitus (T2DM) and included 14 randomized controlled trials (RCTs), comprising 8,487 subjects.

Evidence supports that once-weekly basal insulin analogs achieve comparable glycemic control to daily basal insulin analogs in adults with T2DM, offering greater reductions in HbA1c and improvements in time in range, with a safety profile similar to that of daily insulin regimens. In our analysis, once-weekly basal insulin resulted in a greater reduction in HbA1c compared with daily basal insulin (mean difference [MD] -0.09%, 95% CI -0.15 to -0.03), greater improvements in time in range (TIR) (MD 1.86%, 95% CI 0.73 to 2.98) and higher odds of attaining an HbA1c < 7.0% (OR 1.32, 95% CI 1.07 to 1.63, I2 64.9%). Rates of level 2 or 3 hypoglycemia did not differ significantly.

Once-weekly basal insulin provides glycemic control comparable to daily basal insulin, with modest improvements in glycemic outcomes and similar hypoglycemia risk. Its primary advantage lies in treatment simplification and reduced injection burden, supporting its role as a convenient alternative to daily basal insulin in adults with T2DM.