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Lookup NU author(s): Raheel Ahmed
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2025 The Author(s). Endocrinology, Diabetes & Metabolism published by John Wiley & Sons Ltd.Background: Once-daily basal insulin is widely used in the management of type 2 diabetes, but poor adherence to daily injections often impairs glycaemic control. Once-weekly efsitora alfa may overcome these limitations, but pooled data assessing its comparative efficacy and safety remain limited. Methods: PubMed/MEDLINE, Google Scholar, and the Cochrane Library were searched up to July 2025 for RCTs comparing once-weekly efsitora with once daily insulin in adults with T2D. Weighted mean differences (MDs), odds ratios (ORs), and risk ratios (RRs) were pooled using a random-effects model, and results were reported with 95% confidence intervals. Results: Six RCTs comprising 3967 participants were included. There were no significant differences between once-weekly efsitora and daily insulin in change in HbA1c (MD –0.04; 95% CI –0.10 to 0.02; p = 0.15), change in fasting plasma glucose (MD 1.94 mg/dL; 95% CI –2.98 to 6.86; p = 0.44), proportion of patients achieving HbA1c < 7%, change in body weight, or time below range. Efsitora was associated with an increase in time in range (MD 0.80 percentage points; 95% CI 0.09 to 1.52; p = 0.03) and a reduction in time above range (MD –1.45 percentage points; 95% CI –2.87 to −0.02; p = 0.05). The risk of treatment-emergent adverse events (TEAEs) was higher with efsitora (RR 1.13; 95% CI 1.05 to 1.20; p = 0.0004), whereas serious adverse events, hypersensitivity reactions, injection-site reactions, and hypoglycaemia events were comparable between the two groups. Conclusion: Once-weekly efsitora provides comparable glycaemic control and improved time-in-range compared to daily insulin, although with a higher rate of TEAEs.
Author(s): Mehmood H, Alowami M, Hlaing TS, Zaya KN, Uraiby Y, Alam AM, Adala A, Ikram O, Ali SF, Farhan M, Zulfiqar E, Ahmed M, Ahmed R, Naeem A
Publication type: Review
Publication status: Published
Journal: Endocrinology, Diabetes and Metabolism
Year: 2025
Volume: 8
Issue: 6
Print publication date: 01/11/2025
Online publication date: 28/10/2025
Acceptance date: 14/10/2025
ISSN (print): 2398-9238
ISSN (electronic): 2398-9238
Publisher: John Wiley and Sons Inc
URL: https://doi.org/10.1002/edm2.70126
DOI: 10.1002/edm2.70126
PubMed id: 41152194
Data Access Statement: All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.
