For the roughly 8 million Americans with type 2 diabetes who rely on daily basal insulin, the routine is unforgiving. A shot every day, week after week, adds up to 365 injections a year. That number could drop to 52.
Novo Nordisk this month began the nationwide rollout of Awiqli, the first once-weekly basal insulin approved in the United States. The Food and Drug Administration cleared the drug, whose active ingredient is insulin icodec, on March 26, 2026, as an adjunct to diet and exercise for adults with type 2 diabetes.
Basal insulin is the slow, background insulin that keeps blood sugar steady between meals and overnight. Until now, every long-acting product on the US market has had to be injected daily.
How the weekly formulation works
Insulin icodec is engineered to bind reversibly to a protein in the blood called albumin, which slowly releases the hormone over about a week. The concentrated pen, dosed at 700 units per milliliter, is injected under the skin on the same day each week using a FlexTouch device.
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Awiqli is approved only for type 2 diabetes.
What the trials showed
Approval was built on the ONWARDS phase 3 program. In ONWARDS 3, which randomized 564 insulin-naive adults, average HbA1c, a marker of three-month blood sugar, fell from 8.6 to 7.0 percent with weekly icodec and from 8.5 to 7.2 percent with daily insulin degludec over 26 weeks. Icodec was statistically non-inferior and modestly superior.
The trade-off is hypoglycemia, or low blood sugar. In that same trial, rates of clinically significant or severe low-blood-sugar events were 0.35 per patient-year with icodec compared with 0.12 with the daily comparator, a statistically higher figure. Overall event numbers remained low, but the difference matters because a weekly dose cannot be quickly dialed back if food intake, activity or illness changes.
What it may mean day-to-day
For people who struggle to remember daily shots, or who depend on family or caregivers to give them, cutting injections from seven to one has obvious appeal. Endocrinologists have pointed to older adults, those in assisted living and people with cognitive difficulties as most likely to benefit early on.
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Uptake may still be gradual. Yale endocrinologist Kasia Lipska has predicted the drug will remain a niche product rather than a widely adopted default, reflecting caution about the hypoglycemia signal and the challenge of adjusting a long-acting dose.
Cost sits between the two extremes of the US insulin market. The list price is $99 per pen. Novo Nordisk says people with commercial insurance or Medicare may pay about $35 a month through affordability programs, and uninsured patients about $55.
Daily fingerstick or continuous glucose monitoring is still recommended, and anyone considering a switch from a daily basal insulin should discuss the transition with the clinician who manages their diabetes. Weekly insulin does not replace mealtime insulin for people who need it, and it is not a substitute for the diet, activity and weight management that remain the foundation of type 2 diabetes care.
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This article is made and published by Jesper Bengtson, who may have used AI in the preparation.