Once-Weekly Insulin Arrives in India: Convenience Gains, But Not One Answer for Every Patient

For a person with type 2 diabetes who takes a basal insulin, the year has meant 365 injections. A new product launched in India by Novo Nordisk cuts that to 52. It is called Awiqli, its active ingredient is insulin icodec, and it is the first once-weekly basal insulin available in the country.

The case for it begins with convenience, and the doctors quoted here say so plainly. Dr Vijay Negalur, head of diabetology at KIMS Hospitals in Thane, says that remembering one injection a week is easier than remembering one a day, particularly for people who struggle with missed doses.

The evidence behind the product comes from ONWARDS, a Novo Nordisk programme of six global Phase 3a trials. The programme tested insulin icodec in more than 4,000 adults with type 1 or type 2 diabetes. It found that the weekly insulin lowered HbA1c, the standard measure of average blood sugar, by an amount comparable to once-daily basal insulin, and in some studies slightly more. The overall safety profile was similar. Dr Kovil, another physician quoted in the piece, reads this as meaning patients do not have to give up glucose control in exchange for convenience.

Dr Kovil also points to a behavioural problem. Many people with type 2 diabetes put off starting insulin because they fear daily injections, or they find it hard to stay consistent once they begin. Simpler treatment, he says, improves acceptance, adherence and persistence, which he describes as just as important as the medicine itself, and better compliance often leads to better long-term outcomes.

The insulin is designed to release slowly and act over several days. Early studies show it can match daily long-acting insulin in many adults with type 2 diabetes. But Dr Negalur is careful about the limits. Doctors still have to weigh a patient's age, kidney function, risk of low blood sugar, other medications, and how stable the diabetes is before choosing between weekly and daily dosing.

That last point carries the most weight for some patients. Daily insulin lets doses be adjusted often, in response to blood sugar readings, meals, activity or illness. Dr Negalur says that for people whose insulin needs shift frequently, daily injections may remain the better option, because of the precision they offer.

For others the switch looks easier. Dr Kovil says patients already on a once-daily basal insulin such as glargine or degludec, and who are otherwise suitable, can be considered for a move to the weekly product under medical supervision. He adds that the convenience comes at no extra cost. The experts say the people likeliest to gain are those who forget daily doses, travel often, or find the routine a burden, and for them a weekly shot could noticeably improve quality of life.

Neither doctor suggests the injection replaces anything else. Dr Negalur stresses that regular exercise, a balanced diet, weight management and blood sugar monitoring remain important whatever the dosing schedule.

The framing both doctors settle on is that the question is not which insulin is best for everyone but which suits a given patient. Dr Negalur says the decision should follow a detailed conversation with the treating doctor about blood sugar patterns, lifestyle and long-term goals. Anyone on basal insulin who is curious about weekly dosing has that conversation as the next step.