Diabetes
Elizabeth Briand
CDC estimates that one out of every 10 Americans—or more than 38 million people—has diabetes. For more than a century, insulin has served as a life-saving treatment for people with diabetes. Still, it is a disease that requires vigilant care and medication management, something that many patients can find time-consuming, stressful, and expensive.
A September 10, 2024, article published in NEJM suggested a new medication may be on the horizon to provide an effective alternative for daily insulin treatment for T2D. Called insulin efsitora alfa, it is a basal insulin treatment designed specifically for once-weekly S.C. administration.
A potential game changer
The NEJM study documented the results of the QWINT-2 trial, part of the multiyear QWINT phase 3 global clinical development program for efsitora, led by Eli Lilly and Company and begun in 2022. Results of the QWINT-2 trial showed that efsitora achieved comparable, noninferior A1C reduction in patients when compared to those using once-daily insulin degludec.
“We’re confident in the ability of efsitora to transform and simplify diabetes care,” said Molly Carr, MD, associate vice president, Insulins and Glucagon Development, Eli Lilly and Company. “We’re committed to helping millions of people control diabetes until a cure is found.”
QWINT-2 was a 52-week, phase 3 trial that randomized 928 insulin-naïve adults with T2D from across 10 countries and one territory, including the United States, Brazil, Canada, Germany, Japan, and Puerto Rico. The trial divided the group evenly between those who would receive efsitora once a week and those who would receive degludec once daily. The trial also looked at the efficacy of efsitora in groups of patients who were using and not using GLP-1 receptor agonists.
By the end of the trial, the efsitora group saw their mean A1C decrease from 8.21% at baseline to 6.97% versus a change of 8.24% to 7.05% for the individuals taking daily degludec. The trial also found that patients using efsitora spent 45 minutes more time in range without additional time in hypoglycemia compared with those usingdegludec. The study demonstrated, too, that efsitora was as effective as degludec with respect to the change in the A1C for participants using and not using the GLP-1s.
During the trial, no incidents of severe hypoglycemia were reported for efsitora, and the incidence of adverse events was similar in the two groups.
Because efsitora demonstrated a low peak-to-trough ratio, Carr noted that it has the potential to provide more stable glucose levels for patients throughout the week, providing more peace of mind.
Looking ahead
That concept of peace of mind was a factor in the development of efsitora. “It’s not uncommon when you tell a patient that they have to start insulin that there are tears,” said Carr. The experience of being diagnosed with a serious, chronic condition can upend anyone’s way of life, as can the knowledge that staying ahead of T2D requires ongoing care. A once-weekly medication—versus a daily commitment—could help improve adherence to treatment and reduce some of those natural fears and stressors.
The study noted that reduced injection frequency improved both adherence and glycemic control with once-weekly as compared with once-daily GLP-1s. Ultimately, the weekly treatments could possibly lead to earlier initiation of insulin therapy, and the improved adherence could spur equal improvements in glycemic outcomes.
For pharmacists, the potential of a once-weekly insulin treatment is something that could transform care for their patients, removing the daily need for treatment and giving individuals more freedom and a greater opportunity to manage T2D on their own terms. ■