Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 May;8(3):e70048.
doi: 10.1002/edm2.70048.

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

Obieda Altobaishat  1 , Ahmed Farid Gadelmawla  2 , Suliman Almohtasib  3 , Husam Abu Suilik  4 , AlMothana Manasrah  5 , Mohamed Abouzid  6   7 , Mustafa Turkmani  8   9 , Mohamed Abuelazm  10
Affiliations
Meta-Analysis

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

Obieda Altobaishat et al. Endocrinol Diabetes Metab. 2025 May.

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.

Keywords: T1DM; diabetes mellitus; insulin; meta‐analysis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flow chart of the screening process.
FIGURE 2
FIGURE 2
Quality assessment of risk of bias in the included trials. A schematic representation of risks (low = green, unclear = yellow, and high = red) for specific types of biases in each of the studies in the review.
FIGURE 3
FIGURE 3
Forest plot of the differences in HbA1c levels.
FIGURE 4
FIGURE 4
Forest plot of the differences in fasting blood glucose levels.
FIGURE 5
FIGURE 5
Forest plot of safety outcomes: (a) hypersensitivity reactions, (b) injection site reactions, (c) serious adverse events, and (d) treatment‐emergent adverse events.
FIGURE 6
FIGURE 6
Forest plot of hypoglycemic events, categorised as (a) hypoglycemia level 1, (b) hypoglycemia level 2, (c) hypoglycemia level 3, and (d) hypoglycemia level 2 or 3.
FIGURE 7
FIGURE 7
Forest plot of nocturnal hypoglycemia events, categorised as (a) nocturnal hypoglycemia level 1, (b) nocturnal hypoglycemia level 2, and (c) nocturnal hypoglycemia level 2 or 3.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. CDC , “Diabetes Basics,” (2024), https://www.cdc.gov/diabetes/about/index.html.
    1. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group , “Effectiveness of Continuous Glucose Monitoring in a Clinical Care Environment,” Diabetes Care 33 (2010): 17–22. - PMC - PubMed
    1. American Diabetes Association , “Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2019,” Diabetes Care 42 (2019): S13–S28. - PubMed
    1. Sherr J. L., Laffel L. M., Liu J., et al., “Severe Hypoglycemia and Impaired Awareness of Hypoglycemia Persist in People With Type 1 Diabetes Despite Use of Diabetes Technology: Results From a Cross‐Sectional Survey,” Diabetes Care 47, no. 6 (2024): 941–947. - PMC - PubMed
    1. Flores M., Amir M., Ahmed R., et al., “Causes of Diabetic Ketoacidosis Among Adults With Type 1 Diabetes Mellitus: Insulin Pump Users and Non‐Users,” BMJ Open Diabetes Research & Care 8, no. 2 (2020): e001329. - PMC - PubMed

MeSH terms