Abstract Aims Once‐weekly ( OW ) insulins represent a promising strategy to reduce injection burden and improve adherence in type 2 diabetes management. This meta‐analysis aimed to quantify pooled effect sizes for key biological and clinical outcomes, integrating new findings from the five large trials published in 2025. Materials and Methods We systematically searched PubMed , WoS , ClinicalTrials.gov and EU Clinical Trials databases up to June 2025 for randomized controlled trials ( RCTs ) evaluating OW insulins in type 2 diabetes. Primary outcomes included efficacy ( HbA1c , fasting plasma glucose ( FPG ), time‐in‐range ( TIR ), time‐above‐range) and safety outcomes (body weight, hypoglycaemia, time‐below‐range). Data were analysed using both frequentist and Bayesian approaches. Results Among 435 screened records, 16 RCTs were included. OW insulins achieved a greater reduction in HbA1c compared to once‐daily insulin or semaglutide (pooled mean difference: −0.12%, 95% CI : −0.19 to −0.04, p = 0.007). TIR was significantly longer in the OW insulin group (+2.41% of total time, 95% CI : 1.13 to 3.69, p = 0.002), while FPG changes were comparable (−3.37 mg/ dL , 95% CI : −7.95 to 1.21 mg/ dL , p = 0.14). Body weight changes were generally similar, but excluding trials using IcoSema revealed a modest weight gain (+0.33 kg, 95% CI : 0.04 to 0.62, p = 0.030). The incidence of clinically significant or severe hypoglycaemia did not differ between groups (pooled incidence rate ratio: 1.04, 95% CI : 0.79 to 1.28, p = 0.75). Meta‐regression confirmed consistent effect sizes across OW insulin types, treatment durations and prior insulin regimens. Conclusions OW insulins modestly improve glycaemic control without increasing hypoglycaemia risk, though slight weight gain may occur.
Bourron et al. (Fri,) studied this question.