Once-weekly insulin jab just as good as daily injections, trials find

A new class of insulin taken once a week could be just as effective for managing blood sugar in people with type 1 and type 2 diabetes as daily injections, according to trials.

Reducing jabs “could lessen the burden” for people with the conditions, experts said, although one study found there were higher rates of low blood sugar among type 1 diabetics.

Researchers suggested “additional evaluation” should be made when starting these patients on the drug, and while deciding on their optimal dose.

Findings from two US trials of efsitora, developed by pharma company Eli Lilly, have been presented at the annual meeting of the European Association for the Study of Diabetes in Madrid.

Both explored the drug’s effectiveness when compared to standard insulin, also known as degludec.

Insulin is usually offered to type 2 diabetics when other medications are not managing their blood sugar levels properly.

In people with type 1 diabetes, insulin must be taken every day as their pancreas cannot produce the hormone itself.

A phase 3 trial led by Dr Richard Bergenstal, of the International Diabetes Center, HealthPartners Institute, Minneapolis, included 343 patients with type 1 diabetes on efsitora and 349 on degludec.

All patients were given the drugs in combination with insulin lispro, which was taken at meal times.

At week 26, the mean glycated haemoglobin level (HbA1c) – a measure of how much glucose is attached to haemoglobin, a protein in red blood cells that carries oxygen – decreased from 7.88% to 7.41% in patients on efsitora compared to 7.94% to 7.36% in the degludec group.

However, there was a 21% higher risk of level 2 or level 3 severe hypoglycaemia, also known as low blood sugar, in the efsitora group over 52 weeks.

The highest rates were during the first 12 weeks of treatment.

Dr Bergenstal said: “Our study showed that once-weekly efsitora improved HbA1c in people with type 1 diabetes with similar HbA1c reduction to degludec.

“More work is needed to evaluate efsitora dose initiation and optimisation of basal-bolus insulin dosing to maintain efficacy while mitigating the risk of hypoglycaemia with weekly efsitora treatment in people with type 1 diabetes.”

Another phase 3 trial, conducted by doctors at the MultiCare Rockwood Center for Diabetes and Endocrinology in the US, included 928 people with type 2 diabetes who had not yet started insulin therapy.

The patients were taking oral diabetes drugs but were not meeting their blood sugar goals.

As part of the year-long study, 466 patients were given efsitora and 462 were given degludec.

At week 52, mean HbA1c levels decreased from 8.21% to 6.97% in patients on efsitora compared to 8.24% to 7.05% in the degludec group.

Researchers said: “In adults with type 2 diabetes who had not previously received insulin, once-weekly efsitora was noninferior to once-daily degludec in controlling high blood sugar by reducing glycated haemoglobin levels.

“A once-weekly insulin has the potential to simplify dose administration and diminish barriers to starting insulin therapy by means of a reduction in injection burden as compared with a once-daily insulin.”

The trial also found efsitora could be effectively used by patients on GLP-1 receptor agonists, a family of drugs used to treat diabetes and obesity which includes the likes of semaglutide.

Katie Bareford, senior clinical adviser at Diabetes UK, said: “Everyone with type 1 diabetes and some people with type 2 diabetes need to take regular doses of insulin, either via injections or a pump. Keeping blood sugars in target range with insulin therapy can be relentless and exhausting.

“A reduction in the number of insulin injections could lessen the burden of living with diabetes and better support people in their efforts to manage their diabetes.

“We welcome these findings and look forward to further research on once weekly insulin injections to ensure they are safe and effective for everyone who could benefit.”