- โOnce-weekly insulin efsitora controls blood sugar as well as daily degludec, but people with Type 2 diabetes may have fewer nighttime low blood sugar episodes with efsitora โ while those with Type 1 should discuss higher serious adverse event rates with their doctor.
| Country | Brazil |
| Institution | Federal University of Mato Grosso, Department of Medicine, Sinop, Mato Grosso, Brazil |
| Journal | Journal of diabetes and its complications |
| Year | 2025 |
| PMID | 40627908 |
Brazilian Researchers Compare Once-Weekly Insulin to Daily Degludec
A study from Brazil, published in the Journal of Diabetes and Its Complications (2025), offers an important international look at a new class of ultra-long-acting insulin that could change how Americans with diabetes manage their daily routines. Researchers at the Federal University of Mato Grosso conducted a rigorous systematic review and meta-analysis comparing insulin efsitora โ a once-weekly basal insulin still under regulatory review in the US โ against insulin degludec (Tresibaยฎ), a widely used once-daily basal insulin.
What Makes This Study Unique
Most large insulin trials are funded by manufacturers and conducted primarily in North America or Europe. This Brazilian academic analysis drew on global randomized controlled trial data independently, offering a perspective less influenced by commercial interests. Brazil's publicly funded healthcare system also gives researchers strong motivation to identify which therapies offer the best value and safety โ priorities that translate directly to US patients weighing out-of-pocket insulin costs and convenience.
What the Study Found
The analysis pooled data from six randomized controlled trials involving 2,590 patients, with about half receiving efsitora. Here's what they found:
- Blood sugar control was equivalent: Both insulins produced similar reductions in HbA1c (your 3-month blood sugar average), fasting blood glucose, and body weight. Similar proportions of patients in both groups reached the target HbA1c below 7%.
- Most safety outcomes were comparable: Injection site reactions, allergic responses, severe hypoglycemia (dangerously low blood sugar), and mortality rates were similar between the two insulins overall.
- Important Type 2 diabetes finding: People with Type 2 diabetes using efsitora had fewer nocturnal hypoglycemia events โ that means fewer dangerous low blood sugar episodes during sleep, which can be particularly hazardous.
- Important Type 1 diabetes caution: People with Type 1 diabetes on efsitora showed a higher rate of serious adverse events, a difference that warrants careful discussion with your endocrinologist before any switch.
How This Compares to US Guidelines
Current American Diabetes Association (ADA) guidelines emphasize individualized insulin selection based on a patient's specific health profile, hypoglycemia risk, and lifestyle. This Brazilian meta-analysis directly supports that approach โ its findings suggest that diabetes type significantly shapes how a patient will respond to efsitora versus degludec. The ADA has not yet incorporated efsitora into formal guidelines, as the insulin is still awaiting FDA approval, but this study adds to the growing body of evidence that will inform those future recommendations.
Why This Matters for US Patients
The promise of a once-weekly basal insulin is enormous for Americans who struggle with daily injection routines, travel frequently, or face medication adherence challenges. If efsitora receives FDA approval, it could be a meaningful option โ especially for Type 2 diabetes patients who might also benefit from reduced nighttime lows. However, this study is a clear reminder that one insulin does not fit all. Anyone with Type 1 diabetes should approach this new option with extra caution and close medical supervision.
Staying informed about your insulin options and tracking your blood sugar patterns closely are key steps in working with your care team to find the right fit. Tools and resources at mdsdiabetes.com can help you monitor your levels and have more productive conversations with your doctor about emerging insulin therapies like efsitora.
Full Citation
de Oliveira, Gallo Ruelas, Flรกvio-Reis (2025). Degludec insulin versus efsitora insulin in diabetes mellitus management: A systematic review and meta-analysis. Journal of Diabetes and Its Complications. PMID: 40627908. DOI: 10.1016/j.jdiacomp.2025.109115. Institution: Federal University of Mato Grosso, Sinop, Mato Grosso, Brazil.