For millions of people living with type 2 diabetes, controlling blood sugar can eventually become a daily struggle. When tablets and other medications are no longer enough, doctors may recommend insulin injections to help keep glucose levels under control.
Although insulin can be highly effective, the treatment also comes with challenges. Patients may need regular injections, careful blood sugar monitoring and adjustments to avoid dangerously low glucose levels. Some also experience weight gain, making diabetes management even more complicated.
Now, researchers have discovered that a new once-daily pill could offer an alternative for some patients.
A large international clinical trial found that people taking the medication, called orforglipron, experienced better blood sugar control, substantial weight loss and fewer episodes of dangerously low blood sugar compared with those receiving daily insulin injections.
Also read: Struggling to sleep? Major study links insomnia to a 26% higher stroke risk
But the most surprising result involved something even more important: survival.
According to a study published in The Lancet, patients taking the pill had a 57 percent lower relative risk of dying from any cause during the trial compared with those receiving insulin glargine.
The findings were published online on September 30, 2026, and appeared in the journal's October 17 issue.
However, the researchers emphasize that the trial was primarily designed to investigate cardiovascular safety, not to establish whether the medication prevents deaths.
Also read: New AI tool can predict migraine risk a day early, and the biggest clue surprised researchers
Nearly 2,750 people participated in the experiment
The research, known as the ACHIEVE-4 trial, involved 2,749 adults with type 2 diabetes who also had overweight or obesity and an increased risk of cardiovascular complications.
Most participants already had serious health concerns. Approximately 86 percent had established cardiovascular disease, while nearly 38 percent had chronic kidney disease.
The participants were approximately 63 years old on average and had blood sugar levels that were not adequately controlled by their existing diabetes medications.
Researchers randomly assigned 1,371 people to receive orforglipron and 1,378 to receive insulin glargine, a long-acting insulin commonly used in diabetes treatment.
Also read: A blood test promises to detect over 50 cancers early but a major trial has revealed a problem
Both medications were taken once daily, but they worked differently.
Insulin glargine was administered through injections, while orforglipron was swallowed as a tablet. The pill belongs to a class of medications called GLP-1 receptor agonists, which help regulate blood sugar and appetite.
Participants were followed for a median of two years, allowing researchers to examine both the effectiveness and safety of the treatments over an extended period.
The study's main question was straightforward: Could the daily pill control diabetes without increasing the risk of serious cardiovascular events compared with insulin?
Also read: 7 warning signs your sensitive skin could actually be rosacea
The pill performed at least as well as insulin on heart safety
The researchers focused on four major cardiovascular outcomes: heart-related death, nonfatal heart attack, nonfatal stroke and hospitalization for unstable angina, a condition involving reduced blood flow to the heart.
These events occurred in 4.2 percent of participants receiving orforglipron, compared with 5.0 percent of those receiving insulin glargine.
The difference was not statistically significant enough to establish that the pill was better at preventing cardiovascular events.
However, the results successfully demonstrated what scientists call non-inferiority.
Also read: Women who exercise more report fewer menopause symptoms and one benefit stands out
In simpler terms, the researchers found sufficient evidence that orforglipron was not unacceptably worse than insulin glargine on the trial's main cardiovascular safety measure.
This was an important result because new diabetes medications must demonstrate acceptable safety, particularly when they are intended for people who already have a high risk of heart disease.
But when the researchers examined other outcomes, they discovered an unexpected pattern.
The most surprising result involved the number of deaths
During the trial, 19 people in the orforglipron group died, compared with 43 people in the insulin group.
That represented approximately 1.4 percent of patients taking the pill and 3.2 percent of those receiving insulin.
According to a report published by BioPharm International, a statistical analysis found that the relative risk of death from any cause was 57 percent lower among patients taking orforglipron.
Researchers also identified a 53 percent lower relative risk of cardiovascular death in the pill group.
These results are potentially significant, but they require careful interpretation.
The mortality findings came from prespecified secondary analyses. Although the researchers had planned to investigate them, the trial's statistical testing was not designed to establish a definitive survival benefit.
In particular, the researchers did not apply the additional statistical controls needed to draw firm conclusions from multiple comparisons.
That means the results cannot yet be treated as proof that orforglipron prevents deaths or that it is a safer treatment than insulin for every patient.
The absolute difference in deaths was approximately 1.8 percentage points over the trial period, considerably smaller than the 57 percent relative figure might initially suggest.
Additional studies specifically designed to investigate cardiovascular outcomes and survival will be needed to determine whether the apparent advantage is genuine.
Patients lost weight instead of gaining it
The researchers also found substantial differences in body weight and blood sugar control.
After 52 weeks, patients receiving orforglipron had lost an average of 8.1 kilograms, equivalent to approximately 18 pounds.
Those receiving insulin glargine, meanwhile, gained an average of 1.4 kilograms, or around three pounds.
That created a difference of approximately 9.5 kilograms between the groups after one year.
For people managing type 2 diabetes, body weight can be an important consideration because excess body fat is often associated with insulin resistance, making blood sugar harder to control.
According to Eli Lilly's official announcement of the results, patients taking orforglipron also experienced improvements in several cardiovascular risk factors, including blood pressure, waist circumference and blood lipid measurements.
The researchers observed favorable changes in markers of inflammation and kidney function as well, although these were additional findings rather than the trial's primary outcome.
Taken together, the results suggest that the pill could help address several health challenges commonly experienced by people with type 2 diabetes.
Blood sugar control was also better with the daily pill
Another important finding involved HbA1c, a measurement that reflects a person's average blood sugar levels over approximately two to three months.
Doctors use HbA1c to assess how well diabetes is being managed over time.
At the beginning of the trial, participants had an average HbA1c of approximately 8.2 percent, indicating that their blood sugar levels were above the treatment targets commonly recommended for many adults with diabetes.
After one year, HbA1c had fallen by an average of approximately 1.6 percentage points in the orforglipron group, compared with around 1.0 percentage point among those receiving insulin glargine.
The difference was also reflected in the proportion of patients reaching an HbA1c below 7 percent.
Approximately 65.7 percent of patients taking the pill reached that target, compared with 46 percent of those receiving insulin.
This suggests that orforglipron achieved better average blood sugar control in the patients studied, although individual treatment goals can vary according to age, health conditions and other factors.
The improvements were particularly interesting because they occurred alongside significant weight loss rather than weight gain.
Fewer dangerous blood sugar drops, but more stomach problems
The two treatments also differed considerably in their side effects.
One of the main concerns with insulin therapy is hypoglycemia, which occurs when blood sugar falls too low.
Mild episodes can cause sweating, shakiness, hunger and dizziness. More serious episodes may lead to confusion, fainting or seizures and can sometimes require immediate medical assistance.
In the ACHIEVE-4 trial, clinically significant or severe hypoglycemia occurred in approximately 19.2 percent of patients receiving insulin glargine.
Among those taking orforglipron, the figure was considerably lower at 6.8 percent.
However, the pill had its own disadvantages.
Gastrointestinal side effects, including nausea, vomiting, diarrhea and constipation, were much more common among patients taking orforglipron.
Approximately 62.1 percent of participants in the pill group reported gastrointestinal problems, compared with 14.2 percent in the insulin group.
Most digestive side effects were mild or moderate, but they were troublesome enough that some patients stopped treatment.
During the trial's minimum 52-week treatment period, approximately 10.6 percent of patients taking orforglipron discontinued the medication because of adverse events.
These findings illustrate why the pill should not simply be viewed as an easier or universally better alternative to insulin.
Although swallowing a tablet may be preferable to receiving injections, tolerability and individual medical needs remain important considerations.
How does the new pill actually work?
Orforglipron belongs to the same broad drug family as semaglutide, the active ingredient in Novo Nordisk's Ozempic and Wegovy.
These medications imitate the effects of GLP-1, a hormone released by the digestive system after eating.
GLP-1 helps regulate blood sugar by encouraging the pancreas to release insulin when glucose levels are elevated. It also influences appetite and the speed at which food leaves the stomach.
Together, these effects can improve blood sugar control and help reduce body weight.
What makes orforglipron different is its chemical structure.
Unlike injectable medications such as Ozempic, orforglipron is a small-molecule, non-peptide GLP-1 receptor agonist designed to be taken as a tablet.
Other oral GLP-1 medications already exist, but orforglipron does not require the same restrictions around food and drink as some earlier formulations.
Patients can take the medication once daily without needing to fast beforehand, potentially making treatment more convenient.
The drug is marketed by Eli Lilly under the brand name Foundayo.
Does this mean insulin injections could become unnecessary?
Not necessarily.
Although ACHIEVE-4 produced encouraging results, the participants were a carefully selected group of adults with type 2 diabetes who were already receiving certain glucose-lowering medications.
The study did not establish that every person taking insulin can safely stop using it or switch to orforglipron.
Some patients with type 2 diabetes eventually produce too little insulin and may still require injections to maintain safe blood sugar levels.
Insulin is also essential for people with type 1 diabetes, whose bodies cannot produce sufficient insulin on their own.
There is another important distinction: researchers are not only investigating orforglipron as a replacement for insulin.
In a separate clinical trial published in JAMA in June 2026, scientists studied what happened when orforglipron was added to existing insulin treatment.
That trial involved 546 adults with type 2 diabetes whose blood sugar remained inadequately controlled despite receiving insulin glargine.
Researchers found that adding orforglipron improved blood sugar levels and reduced body weight compared with adding a placebo.
This suggests that the medication could potentially serve different roles in diabetes management, either as an alternative to insulin in appropriate patients or as an additional treatment when necessary.
However, treatment decisions must be made individually.
The pill is already approved, but the rules differ between countries
Orforglipron has already reached the market, although its approved uses vary depending on the country.
In the United States, the Food and Drug Administration approved Foundayo for chronic weight management on April 1, 2026.
The approval applies to adults with obesity and certain adults with overweight who also have weight-related health conditions.
As of October 20, 2026, the FDA has not approved Foundayo specifically for the treatment of type 2 diabetes, although Eli Lilly has submitted an application for that indication.
The situation is different in the United Kingdom.
On August 10, 2026, the UK Medicines and Healthcare products Regulatory Agency authorized orforglipron for both weight management and type 2 diabetes.
There has also been an important development in the European Union.
On October 15, 2026, the European Medicines Agency's Committee for Medicinal Products for Human Use adopted a positive opinion recommending authorization of Foundayo for both conditions.
However, that recommendation is not the same as final European Commission approval, which is still required before the medicine receives an EU-wide marketing authorization.
For patients, this means access depends on where they live, the reason for treatment and the applicable prescribing and reimbursement rules.
What people with type 2 diabetes should take from the findings
The ACHIEVE-4 results represent an important development in diabetes research.
The new pill demonstrated cardiovascular safety comparable to daily insulin glargine in the trial's selected population, while producing better average blood sugar control and substantial weight loss.
It was also associated with fewer clinically significant or severe low blood sugar episodes, although digestive side effects were much more common.
And the lower number of deaths among patients receiving orforglipron is a finding that deserves further investigation.
But researchers are not yet in a position to conclude that taking the pill prevents premature death or that it should routinely replace insulin.
Dr. Klara Klein, an assistant professor at the University of North Carolina School of Medicine and the trial's lead investigator, emphasized the importance of considering cardiovascular health alongside diabetes management.
"For people living with type 2 diabetes, protecting the heart is as important as controlling blood sugar," she said, in comments also reported by Medical Update Online.
For patients already using insulin, the findings provide a reason to discuss treatment options with their healthcare professional, particularly if weight gain, low blood sugar episodes or the practical difficulties of injections are affecting daily life.
However, nobody should reduce or stop insulin based on these findings alone.
Changing diabetes medication without medical supervision can cause dangerous changes in blood sugar levels, and not every patient will be suitable for GLP-1 treatment.
The most important unanswered question is whether the lower death rate observed in ACHIEVE-4 will be confirmed in future trials specifically designed to test cardiovascular benefits.
If it is, the discovery could eventually influence how doctors treat people with type 2 diabetes who face a high risk of heart disease.
For now, the results offer a promising new treatment possibility, but not a reason to abandon insulin or assume that a daily pill will automatically lead to a longer life.
This article is made and published by Aksel Kryhlmand, who may have used AI in the preparation.