Once-Weekly Insulin Versus Once-Daily Insulin for Type 1 Diabetes Treatment: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

IF 2.7 Q3 ENDOCRINOLOGY & METABOLISM

Endocrinology, Diabetes and Metabolism Pub Date : 2025-04-04 DOI:10.1002/edm2.70048

Obieda Altobaishat, Ahmed Farid Gadelmawla, Suliman Almohtasib, Husam Abu Suilik, AlMothana Manasrah, Mohamed Abouzid, Mustafa Turkmani, Mohamed Abuelazm

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Abstract

Background

Type 1 diabetes mellitus (T1DM) represents a considerable global health burden, affecting approximately 5%–10% of individuals with diabetes. Once-weekly basal insulin could substantially reduce the number of injections for T1DM patients from 365 daily to 52 weekly doses annually. Therefore, this meta-analysis compares the safety and efficacy of once-weekly insulin formulations.

Methods

The systematic review and meta-analysis included the relevant randomised controlled trials (RCTs) retrieved from PubMed, EMBASE, Web of Science, Cochrane, and SCOPUS databases until September 2024. The meta-analysis was performed using (RevMan 5.4.1). The study protocol was registered on PROSPERO (CRD42024603022).

Results

Three RCTs comprising 1724 participants were included. Once-daily insulin significantly decreased glycated haemoglobin (HbA1c) compared to once-weekly insulin (estimated treatment difference: 0.09%, 95% CI [0.07, 0.11], p < 0.00001). Fasting blood glucose levels were comparable between the once-weekly and once-daily insulin groups (estimated treatment difference: 0.44 mg/dL, 95% CI [−0.64, 1.52], p = 0.42).

Once-weekly insulin was associated with a significant increase in the incidence of injection site reactions (RR: 3.48 with 95% CI [1.30, 9.31], p = 0.01), serious adverse events (RR: 1.55 with 95% CI [1.09, 2.19], p = 0.01), and treatment-emergent adverse events (RR: 1.12 with 95% CI [1.02, 1.23], p = 0.02), while no significant difference was observed in hypersensitivity reactions (RR: 1.04 with 95% CI [0.78, 1.38], p = 0.79).

Conclusion

Once-daily insulin has demonstrated slightly superior HbA1c reduction, while once-weekly insulin offers potential advantages in patient adherence. However, these benefits must be weighed against an increased risk of injection site reactions and nocturnal hypoglycemia. Although once-weekly insulin is more convenient, treatment decisions should consider individual patient factors such as hypoglycemia risk and tolerance to injection reactions.

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1型糖尿病治疗：每周一次胰岛素vs每日一次胰岛素：随机对照试验的系统评价和荟萃分析

1型糖尿病（T1DM）是一个相当大的全球健康负担，影响了大约5%-10%的糖尿病患者。每周一次的基础胰岛素可以大大减少T1DM患者的注射次数，从每天365次减少到每年52次。因此，本荟萃分析比较了每周一次胰岛素制剂的安全性和有效性。方法系统评价和荟萃分析包括PubMed、EMBASE、Web of Science、Cochrane和SCOPUS数据库中截至2024年9月的相关随机对照试验（RCTs）。meta分析采用RevMan 5.4.1软件进行。研究方案已在PROSPERO上注册（CRD42024603022）。结果纳入3项随机对照试验，共1724名受试者。与每周一次胰岛素相比，每天一次胰岛素显著降低糖化血红蛋白（HbA1c）（估计治疗差异：0.09%,95% CI [0.07, 0.11], p < 0.00001）。空腹血糖水平在每周一次和每天一次胰岛素组之间相当（估计治疗差异：0.44 mg/dL, 95% CI [- 0.64, 1.52], p = 0.42）。每周一次胰岛素治疗与注射部位反应（RR: 3.48, 95% CI [1.30, 9.31], p = 0.01）、严重不良事件（RR: 1.55, 95% CI [1.09, 2.19], p = 0.01）和治疗后出现的不良事件（RR: 1.12, 95% CI [1.02, 1.23], p = 0.02）的发生率显著升高相关，而超敏反应(RR：1.04, 95% CI [0.78, 1.38], p = 0.79)。结论：每日一次胰岛素可略微降低HbA1c，而每周一次胰岛素在患者依从性方面具有潜在优势。然而，这些益处必须与注射部位反应和夜间低血糖的风险增加相权衡。虽然每周一次的胰岛素治疗更方便，但治疗决定应考虑患者的个体因素，如低血糖风险和对注射反应的耐受性。

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