- Lilly’s once-weekly basal insulin Onswik was just approved by the FDA. It’s the second weekly basal insulin approved this year for type 2 diabetes, following Novo Nordisk’s Awiqli.
- Clinical trials for both Onswik and Awiqli showed that weekly basal insulins controlled blood sugar just as well as daily basal insulins, with a similar reduction in A1c.
- The risk of severe hypoglycemia in type 2 diabetes for both weekly insulins was about the same in the clinical trials as with daily basals. However, hypoglycemia risk was higher in studies for type 1 diabetes.
- Once-weekly basal insulin isn’t approved for anyone under the age of 18, for women who are pregnant, or for people with type 1 diabetes.
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What if your life with type 2 diabetes could be a little easier? There are now two FDA-approved once-weekly basal insulins!
Lilly’s once-weekly basal insulin Onswik was just approved by the FDA, giving people with T2D another option for basal insulin therapy.
The approval of Onswik follows on the heels of Novo Nordisk’s Awiqli, which was cleared by the FDA in March and is already available in U.S. pharmacies. Onswik will be available in the U.S. in the coming months.
Both weekly basals deliver a steady supply of insulin that lasts an entire week, reducing the number of injections from 365 per year down to just 52.
Could weekly basal insulin be right for you? Here’s what you need to know about these new insulins.
What Is Basal Insulin?
Basal insulin is the long-acting “background” insulin that works around the clock to help keep your blood sugar steady between meals and overnight.
Unlike fast-acting insulin, which is taken at mealtimes to cover the rise in blood sugar from what you eat, a good basal insulin works slowly and steadily, without big peaks and valleys.
Common brands of basal insulin include the older, first-generation brands like Lantus and Levemir, and the newer, second-generation basals like Tresiba and Toujeo.
Many people with type 2 diabetes eventually need basal insulin because type 2 diabetes is a progressive condition. That means that over time, your pancreas may produce less insulin, and your body may become less responsive to the insulin you do make.
As a result, your blood sugar can become harder to control, even if you’re doing everything “right.”
How Does Weekly Basal Insulin Work?
What makes weekly insulin different is the way it’s delivered.
Awiqli attaches to albumin, a protein naturally present in the blood. Think of albumin as a storage reservoir: it holds most of the insulin, with small amounts gradually becoming available to work. The insulin is also modified to resist breakdown.
Onswik links insulin to a piece of an antibody called the Fc portion. This acts like a protective carrier, slowing the insulin’s removal and allowing it to be recycled back into the bloodstream instead of quickly broken down. That keeps its glucose-lowering effect going throughout the week.
Weekly basal insulin is injected subcutaneously into the thigh, upper arm, abdomen, or just about any place on your body with subcutaneous fat, just like daily basal insulin. Both Awiqli and Onswik provide a steady basal insulin effect over seven days.
Is Weekly Basal Insulin as Effective as Daily Basal Insulin?
The short answer is yes.
Onswik was studied in over 3,400 adults with type 2 diabetes in the QWINT clinical trials, with results showing that it lowered A1c at least as well as daily basal insulin, and in some cases more.
The ONWARDS trials for Awiqli included nearly 3,800 adults with type 2 diabetes, and researchers found that Awiqli was also just as effective at lowering A1c and providing blood sugar control as daily basals.
Many study participants in both trials said they liked the convenience of weekly insulin, preferring it over the daily basal insulin option.
Once-Weekly Insulin Safety & Side Effects
The risk of severe hypoglycemia in the type 2 diabetes clinical trials for both weekly insulins was about the same as with daily basals.
However, low blood sugar can happen with any insulin or glucose-lowering medication, so you still need to know the signs and symptoms of hypoglycemia and know how to treat a low blood sugar if it does occur.
In studies involving people with type 1 diabetes, weekly basal insulin was associated with a higher risk of hypoglycemia, so it’s not currently approved in the United States for people with type 1.
Pros and Cons of Once-Weekly Basal Insulin
As with any medication or treatment therapy, there are benefits and trade-offs. Your doctor can help weigh the pros and cons to see if weekly insulin would be a good fit.
Pros of Weekly Insulin:
- Fewer injections: One injection per week instead of seven.
- Reduced treatment fatigue: Fewer injections can make insulin feel less burdensome.
- Potential for better adherence: A simpler routine could make it easier to stay on track.
- Simpler for care settings: It could be easier for people who receive insulin from caregivers.
Cons of Weekly Insulin:
- Longer initial start-up period: It can take a few weeks for weekly insulin to reach its target level, and finding the right dose requires close monitoring with your healthcare team.
- Harder to change course quickly: It can be harder to make rapid adjustments if your insulin needs change. For example, if you get sick or are hospitalized and you stop the medication, the effects don’t wane as quickly as with daily basal insulin.
Weekly Basal Insulin: Frequently Asked Questions
💉 Who might benefit the most from weekly basal insulin?
Weekly insulin may be especially helpful for people who struggle to keep up with daily injections, are nervous about starting insulin therapy, have a busy or unpredictable schedule, who want a simpler routine, or who depend on others to administer insulin for them.
🚫 Is there anyone who should NOT use once-weekly insulin?
Once-weekly basal insulin isn’t approved for anyone under the age of 18, for women who are pregnant, or for people with type 1 diabetes. Your healthcare provider can help determine if a once-weekly option is a safe and appropriate fit for you.
⏭️ What happens if you miss a dose of weekly basal insulin?
If you are on Awiqli and you miss a dose, take it as soon as you remember within four days. The day you take it becomes your new “anchor” day. For example, if you normally take your weekly insulin on a Sunday and you don’t take it until Tuesday, Tuesday becomes your new anchor day moving forward.
If you are on Onswik and you miss a dose, take it as soon as you remember within four days. However, don’t change your normal anchor day.
If it’s been over four days for either of the weekly insulins, skip it and administer it on your regularly scheduled anchor day. Just make sure to monitor your blood sugar more often when you miss a dose of weekly basal insulin.
🤝 Are weekly basal insulins covered by insurance?
Many commercial insurance plans and Medicare plans cover Awiqli, but coverage will vary depending on your individual plan. Onswik will be available in the U.S. in the coming months, so we’ll know more about insurance coverage soon.
💊 Can you take weekly basal insulin with other diabetes medications, including mealtime insulin?
Weekly basal insulins can be used with other diabetes medications like metformin, GLP-1s, SGLT2s, and mealtime (fast-acting) insulin. You can even take a weekly insulin on the same day as your GLP-1. Your healthcare provider may need to adjust your other medications and/or your weekly basal insulin dose to help keep your blood sugar in your target range.
👯♀️ Is there a difference between Awiqli and Onswik?
From what we know from the clinical trials, there are more similarities between the two products than differences, but the main difference is the mechanism of action. Also, both insulins have a more involved start-up period than their daily basal counterparts, neither is approved for use in type 1 in the United States, and both have names that are hard to pronounce!
Weekly Basal Insulin: Key Takeaways
For many people with type 2 diabetes, taking basal insulin once a week instead of every day could have a positive impact on their diabetes management, offering more convenience and relief from daily injections. It may also make starting insulin feel less overwhelming for those who are brand new to insulin therapy.
In clinical trials, both Awiqli and Onswik lowered A1c at least as well as daily basal insulin, and many study participants said they preferred the convenience and fewer injections.
Weekly insulin won’t be the right fit for everyone, so talk with your healthcare team if you’re interested in learning whether it might be a good option for you. Just like shoes, insulin therapy is not a one-size-fits-all situation. The best regimen is the one that controls your blood sugar well and fits into your lifestyle. Thankfully, there are more options now than ever before.
This content was made possible with support from Lilly, a partner of Taking Control of Your Diabetes® at the time of publication.
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