One Injection, One Week: Novo Nordisk Clears a New Bar

Novo Nordisk's Awiqli cuts basal insulin injections from seven per week to one after FDA approval on March 26, 2026

9 Apr 2026

For millions of Americans managing type 2 diabetes, the daily injection routine may finally have an expiration date. The FDA approved Awiqli, a once-weekly basal insulin from Novo Nordisk, on March 26, 2026, the first of its kind to reach US patients and the most significant shift in insulin therapy in more than two decades.

The math is simple: one injection a week instead of seven. Awiqli works by binding to albumin, a protein naturally found in the blood that acts as a slow-release reservoir, delivering steady insulin levels throughout the week. That consistency matters, because daily injection burdens are a well-documented reason patients delay or abandon insulin therapy entirely.

Clinical backing is substantial. The ONWARDS phase 3a program, four large randomized trials involving roughly 2,680 adults with poorly controlled type 2 diabetes, found that once-weekly Awiqli matched or outperformed daily basal insulins in reducing HbA1c, the standard marker of long-term blood sugar control. In one trial, insulin-naive patients on Awiqli spent 71.9 percent of the time in their target glucose range, compared to 66.9% for those on daily insulin.

There are caveats. Hypoglycemia, the most common side effect, tends to peak in the first two to four days of each weekly cycle. Patients switching from daily regimens should monitor blood glucose closely during the transition.

Awiqli has already cleared regulators in the EU, Canada, Australia, Japan, and more than a dozen other countries. US nationwide availability is expected in the second half of 2026. Eli Lilly is close behind with its own once-weekly contender, efsitora alfa, signaling that weekly dosing is quickly becoming the new standard in insulin innovation.

For patients who rely on caregiver support or simply struggle to keep up with daily routines, the shift to weekly dosing is more than a convenience upgrade. It's a structural rethink of how insulin therapy fits into real life.