Novo Nordisk has introduced Awiqli, the world's first once-weekly basal insulin injection, to the Indian market, offering a potential alternative to daily insulin regimens for adults with type 1 and type 2 diabetes. This new formulation utilizes insulin icodec, which binds to albumin in the blood to ensure a steady release of insulin, thereby maintaining stable blood sugar levels throughout the week and addressing the significant burden of daily injections, which can improve long-term diabetes outcomes and patient adherence by reducing injections from 365 to 52 annually. Awiqli provides flexibility in managing missed doses and is approved for adults, though it requires careful consideration by a physician and must be used with mealtime insulin for type 1 diabetes patients, while being contraindicated for children, pregnant or breastfeeding women, and during episodes of hypoglycemia. The launch is expected to alleviate psychological barriers associated with daily insulin management, encouraging earlier treatment initiation and better overall health in a country with a high prevalence of diabetes and suboptimal blood sugar control.

Novo Nordisk has introduced Awiqli, the world's first once-weekly basal insulin injection, to the Indian market, offering a potential alternative to daily insulin regimens for adults with type 1 and type 2 diabetes. This new formulation utilizes insulin icodec, which binds to albumin in the blood to ensure a steady release of insulin, thereby maintaining stable blood sugar levels throughout the week and addressing the significant burden of daily injections, which can improve long-term diabetes outcomes and patient adherence by reducing injections from 365 to 52 annually. Awiqli provides flexibility in managing missed doses and is approved for adults, though it requires careful consideration by a physician and must be used with mealtime insulin for type 1 diabetes patients, while being contraindicated for children, pregnant or breastfeeding women, and during episodes of hypoglycemia. The launch is expected to alleviate psychological barriers associated with daily insulin management, encouraging earlier treatment initiation and better overall health in a country with a high prevalence of diabetes and suboptimal blood sugar control.

Novo Nordisk has introduced Awiqli, the world's first once-weekly basal insulin injection, to the Indian market, offering a potential alternative to daily insulin regimens for adults with type 1 and type 2 diabetes. This new formulation utilizes insulin icodec, which binds to albumin in the blood to ensure a steady release of insulin, thereby maintaining stable blood sugar levels throughout the week and addressing the significant burden of daily injections, which can improve long-term diabetes outcomes and patient adherence by reducing injections from 365 to 52 annually. Awiqli provides flexibility in managing missed doses and is approved for adults, though it requires careful consideration by a physician and must be used with mealtime insulin for type 1 diabetes patients, while being contraindicated for children, pregnant or breastfeeding women, and during episodes of hypoglycemia. The launch is expected to alleviate psychological barriers associated with daily insulin management, encouraging earlier treatment initiation and better overall health in a country with a high prevalence of diabetes and suboptimal blood sugar control.

Novo Nordisk recently launched its weekly basal insulin injection, Awiqli, in India, in a move that could compete with daily-dose options for patients on the market.

The company describes it as the world's first once-weekly basal insulin approved for clinical use, which is prescribed for the treatment of type 1 and type 2 diabetes in adults.

Priced at ₹261 per week for 70 units, Awiqli is available in 2 volume variants: a 1 ml (700-unit) pen priced at ₹2,611, and a 3 ml (2,100-unit) pen priced at ₹7,833.

In an email interview with THE WEEK, Dr Ravisankar Erukulpati, Senior Consultant Endocrinologist, Apollo Hospitals, Jubilee Hills, Hyderabad, discussed the efficacy of the once-weekly basal insulin injection.

Excerpts:

Q/ When patients hear 'once a week,' some may wonder whether it can work as effectively as daily insulin. How does Awiqli help maintain stable blood sugar control throughout the week?

A/ The launch of Awiqli fundamentally redefines the overall insulin experience for a diabetes patient by reducing the injection burden from 7 to 1 per week. Insulin icodec binds to albumin, a protein in the blood, creating a steady, inactive depot that ensures a steady release of insulin. Thus, the insulin level in the blood does not peak and drop throughout the week; it remains stable from Day 1 to Day 7.

Q/ Being the world's first once-weekly basal insulin, how does it improve long-term diabetes outcomes?

A/ Once-weekly basal insulin is a dream come true for a patient living with diabetes because it fulfils major unmet needs –

Inconvenience & fear of daily pricks: A once-weekly basal insulin brings down the injection burden from 365 to 52 in a year, thereby offering convenience in one’s daily lifestyle.   

Clinical superiority: Awiqli delivers superior HbA1c reduction and significantly improved Time-in-Range (TIR) compared to standard daily basal insulin (glargine U100). This was shown in the robust global ONWARDS clinical trial programme.

Improved adherence: Indian patients living with diabetes delay insulin initiation by 7-9 years, leaving over 80 per cent of patients living with unsafe HbA1c levels (≥7 per cent) and increasing their long-term risk for diabetic complications. At the same time, doctors may sometimes avoid initiating insulin for patients due to complex dosing schedules and the fear of side effects like weight gain or low blood sugar (hypoglycaemia). With a once-weekly basal insulin, these challenges are better addressed.

Q/ If a patient accidentally misses their weekly dose, does that pose a bigger challenge than missing a single daily injection? Are there any risks involved?

A/ In case a patient with diabetes misses their weekly dose, they can take it within 3 days, check their fasting blood sugar, and stick to the original weekly schedule. 

If more than 3 days have passed, then the patient should still take the missed dose as soon as they remember, but that specific day will now become the new weekly injection day.

If the original schedule is preferred, the patient can slowly adjust the timing over the following weeks to come back to the original schedule. The patient should consult their doctor for support.

For a patient with type 1 diabetes, the missed dose must be taken the moment they remember, and that day immediately becomes the new weekly schedule. This flexibility makes it simpler and safer than navigating a missed daily basal insulin.

Q/ Who benefits the most from this once-weekly option? Are there any criteria for the kind of patients who should take these injections?

A/ Awiqli is approved for adults (≥18 years) living with Type 1 or Type 2 diabetes. For patients with Type 2 diabetes, it can be prescribed on its own or used alongside the current diabetes medications.

For individuals with Type 1 diabetes, it is important to remember that it must always be paired with regular mealtime insulin as part of a daily routine to handle blood sugar spikes after eating. Awiqli is a prescription-only medicine, and because every patient’s health profile is different, a doctor should evaluate and decide on the right regimen.

Like most insulins, this injection must never be used during active episodes of low blood sugar (hypoglycaemia) or if the patient is allergic to insulin icodec. Furthermore, because there is no clinical safety data for younger populations or mothers yet, it must not be used by children under 18, or women who are pregnant or breastfeeding.

Q/ Do you think a once-weekly insulin can change the mindset of the general population, or are there deeper psychological barriers we still need to address?

A/ The scale of the diabetes challenge in India is immense, with over 101 million people living with the condition and more than 80 per cent maintaining an unsafe, suboptimal HbA1c level of 7 per cent or higher. The main reason patients delay starting insulin by 7 to 9 years is a mix of deeply rooted fears and lifestyle challenges. Patients worry about injection pain, anxiety over needles, cost and the sheer complexity of managing daily doses. At the same time, doctors worry about how well a busy patient can stick to a daily schedule, alongside the risks of weight gain or sudden low blood sugar.

Studies show that maintaining daily compliance is highly challenging for up to 59 per cent of patients, which inevitably leads to missed doses and unstable blood sugar levels. This is exactly why a once-weekly option can completely change the patient’s mindset.

When 93 per cent of patients express a powerful psychological preference to maintain control without the physical burden of daily pricks, a weekly routine can address their concerns. It shifts insulin from being a daily, stressful reminder of illness into a simple, highly manageable weekly habit. By removing the daily friction of needles, we can break these psychological barriers and help patients accept treatment much earlier and secure their long-term health.

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