Comparing Once-Weekly Insulin Efsitora with Once-Daily Insulin Degludec: Fewer Injections, Fewer Problems?

So before we get into the specifics about the QUINT3 trial, let's set the stage a little.

Type 2 diabetes is one of the most prevalent chronic conditions we manage in ambulatory care and community pharmacy practice.

Can you help our listeners understand the clinical burden of managing type 2 diabetes, particularly for patients who require insulin therapy, and why adherence with medications remains really such a challenge?

As we know, type 2 diabetes is a progressive disease.

Patients may start with lifestyle and dietary modifications and then progress to needing oral medications.

But over time, insulin resistance will worsen, making the blood sugars more difficult to control.

Along with this, there is a proportion of patients who are limited to utilizing certain medications due to altered kidney functions, side effects, or costs.

Many patients may eventually require multiple medications, and a proportion of patients will need insulin as part of their long-term management.

Once this occurs and a patient starts using insulin, the daily burden of diabetes care increases drastically.

It's estimated that patients who have diabetes think about their diabetes for over an hour a day, considering diet, management, checking blood sugars.

And this cognitive burden only increases if patients are also prescribed insulin.

Patients prescribed insulin therapies may need to inject anywhere between once to up to four times a day or more.

And each injection requires setting up a new needle, preparing the injection site, and some may even have to calculate their insulin doses prior to injection.

In addition, patients using insulin are at higher risk for hypoglycemia, so careful monitoring of blood glucose throughout the day is going to be essential.

As you can see, this is where adherence can become a major barrier for patients.

Roughly half of our patients prescribed basal insulin are non-adherent, which can also have serious complications.

When insulin is not taken consistently and blood sugars are not well controlled, the risk of both microvascular and macrovascular complications increases.

This can lead to complications such as retinopathies, kidney disease, strokes, cardiovascular events, or heart attacks.

Even short-term non-adherence can lead to acute emergencies like severe hyperglycemia.

The recent development and management of diabetes are aiming to simplify treatments to improve adherence.

We've seen how once-weekly administrations of medications, such as GLP-1 receptor agonists, have improved adherence when compared to their once-daily options.

The increase in adherence raised the question if a once-weekly insulin could have the same impact by reducing the day-to-day burden of diabetes management.

There's a lot going on in diabetes, and being able to address medication adherence and people's ability to manage that cognitive burden with medications is a huge role of the pharmacist.

I'm a community pharmacist by training and practice in a population health setting, and so I spend all of my time talking with students about how do we help patients with their adherence? Is it something that they're struggling to remember to take every day? Is it cost? Is it access? Is it storage? It could be a million things.

We could talk for an hour about the things that impact a patient's medication adherence.