Use of Continuous Glucose Monitoring Indicators to Guide Dose Titration of Weekly Basal Insulin Efsitora Alfa in Insulin-Naive and Basal Insulin-Experienced Adults with Type 2 Diabetes: A Retrospective Analyis

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Publication Details

Journal
Diabetes Technology & Therapeutics
Published
2026-09-17
DOI
https://doi.org/10.1177/15209156261485755
Primary Topic
Diabetes Management and Research
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article
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article

Use of Continuous Glucose Monitoring Indicators to Guide Dose Titration of Weekly Basal Insulin Efsitora Alfa in Insulin-Naive and Basal Insulin-Experienced Adults with Type 2 Diabetes: A Retrospective Analyis

Eyal Dassau, Liza L. Ilag, David L. Duke, Thomas W. Martens et al.
Diabetes Technology & Therapeutics
Diabetes Management and Research
article

Use of Continuous Glucose Monitoring Indicators to Guide Dose Titration of Weekly Basal Insulin Efsitora Alfa in Insulin-Naive and Basal Insulin-Experienced Adults with Type 2 Diabetes: A Retrospective Analyis

Eyal Dassau, Liza L. Ilag, David L. Duke, Thomas W. Martens, Grazia Aleppo, Michael Case, JENNAL JOHNSON, Michael B. Davidson, Richard M. Bergenstal, David Ahn, Eden M. Miller
article en

Abstract

INTRODUCTION: Basal insulin dose titration has historically relied on fasting self-monitoring blood glucose (SMBG) and hypoglycemic events. This retrospective analysis of the QWINT-2 and QWINT-3 Phase 3 trials aimed to evaluate the use of continuous glucose monitoring (CGM)-derived indicators for weekly insulin efsitora alfa (efsitora) titration in insulin-naive and basal insulin-experienced adults with type 2 diabetes (T2D) through dose-to-dose comparisons with self-monitoring fasting plasma glucose (FPG) and CGM-derived hypoglycemic events, and by assessing concordance between CGM fasting indicators and FPG independent of insulin dose adjustment. METHODS: = 655) efsitora-treated participants were analyzed. CGM fasting indicators were compared with FPG through weekly dose-to-dose titration decisions following the SMBG-based Phase 3 trial dose titration algorithm, and by assessing concordance between CGM fasting indicator and FPG values. CGM hypoglycemia indicators were assessed weekly for agreement with CGM-derived hypoglycemic events below 70 mg/dL and 54 mg/dL following the SMBG-based Phase 3 trial hypoglycemia criteria. User burden was considered, with low burden meaning a CGM indicator was readily available in an ambulatory glucose profile (AGP) report. RESULTS: CGM hypoglycemia indicators demonstrated 91.5%-98.3% agreement with CGM-derived hypoglycemic events in QWINT-2 and QWINT-3. CGM fasting indicators "Lowest median of AGP," and "Typical fasting 25% from AGP" demonstrated clinical equivalency with FPG, with dose differences within 20 weekly units for 90.7%-93.4% of dose decisions for both studies. CONCLUSION: In insulin-naive and basal insulin-experienced populations treated with weekly efsitora, CGM indicators of hypoglycemia and fasting glucose yielded clinically equivalent dose titration decisions as CGM-derived hypoglycemic events and self-monitoring FPG, respectively. These findings support translation of established titration practices to a CGM-based workflow in insulin-naive and basal insulin-experienced adults with T2D, consistent with recommendations for CGM use in adults with diabetes on insulin therapy.

Diabetes Technology & Therapeutics
Northwestern University (US), Hoag Memorial Hospital Presbyterian (US), Eli Lilly (United States) (US), Diabetes Australia (AU), Park Nicollet Health Services (US), Park Nicollet Clinic (US), HealthPartners (US)
Good health and well-being
Openalex Percentile: Top 11%
Diabetes Management and Research
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