Comparing the efficacy of once-weekly insulin analogs versus daily basal regimens in type 2 diabetes mellitus: a systematic review and meta-analysis

Insulin therapy plays a crucial role in the management of type 2 diabetes mellitus as the disease progresses. To enhance patient adherence and convenience, once-weekly basal insulin analogs such as insulin icodec and insulin Fc have been developed. This systematic review and meta-analysis evaluated the efficacy of once-weekly basal insulin compared to daily basal insulin in people with type2 diabetes mellitus. We searched pubmed, cochrane library and clinical trials database up to December 4th, 2024, and identified 4,071 records, of which 11 randomized controlled trials (5,976 participants) met inclusion criteria. Seven studies involved insulin-naive individuals. The findings indicated that once-weekly basal insulin led to a slightly greater reduction in glycated hemoglobin and an improvement in time in range compared to daily basal insulin. Similar proportions of patients achieved glycated hemoglobin levels below 7%, and no significant differences were observed in changes in body weight or fasting plasma glucose between the groups. The benefits of weekly insulin on glycated hemoglobin were consistent regardless of previous insulin use. This study suggests that once-weekly basal insulin may be an effective and convenient alternative to daily administration for people with type 2 diabetes mellitus.