Awiqli: A Once-Weekly Insulin Option for Adults With Type 2 Diabetes

For millions of Americans, insulin is part of everyday diabetes care.

An estimated 8.4 million Americans use insulin to help manage diabetes. For many patients, insulin is one of the most effective medication therapies available for lowering A1c. When blood sugar remains above goal despite lifestyle changes and other medications, insulin can be an important next step.

But starting insulin is not always easy.

Even when insulin is clinically appropriate, patients may delay it, avoid it, or struggle to stay consistent. That is not just a medical issue. It is also a practical and emotional one.

Some patients worry about needles. Others worry about weight gain, low blood sugar, pain with injections, or the idea that needing insulin means their diabetes has “gotten worse.” For some, the daily routine itself becomes the barrier.

That is why the FDA approval of Awiqli, also known as insulin icodec-abae, is worth paying attention to.

Awiqli is a long-acting basal insulin approved for adults with type 2 diabetes. Unlike traditional daily basal insulin, Awiqli is designed to be injected once weekly on the same day each week.

Why Insulin Works, But Still Feels Hard for Many Patients

Insulin is powerful because it directly helps lower blood sugar. It remains one of the most effective options for A1c reduction, especially when other diabetes treatments are not enough.

The challenge is that insulin only works when patients can realistically use it.

Common barriers to insulin use include:

• Fear of needles
• Fear of injections
• Concern about hypoglycemia, or low blood sugar
• Worry about weight gain
• Difficulty keeping up with daily injections
• Feeling overwhelmed by the idea of starting insulin
• Concerns about dosing mistakes
• Anxiety about needing insulin in public or around others

These barriers matter because they can delay treatment. A patient may need insulin, but if the daily injection routine feels intimidating or complicated, they may be less likely to start or stay consistent.

That is where a once-weekly option could make a difference.

What Makes Awiqli Different

Awiqli is still insulin. It is not a shortcut and it does not remove the need for careful monitoring.

The difference is the schedule.

Instead of taking basal insulin every day, eligible adults with type 2 diabetes may be prescribed Awiqli once weekly. For some patients, reducing basal insulin injections from daily to weekly may make treatment feel more manageable.

That could be especially helpful for patients who:

• Have been hesitant to start insulin
• Struggle with daily injection routines
• Experience injection fatigue
• Feel overwhelmed by medication schedules
• Need a basal insulin option that may better fit their lifestyle

Awiqli is used along with diet and exercise to improve glycemic control in adults with type 2 diabetes. It is injected under the skin and should be taken once weekly on the same day each week.

What the ONWARDS 3 Trial Showed

One of the key studies behind once-weekly insulin icodec was the ONWARDS 3 randomized clinical trial.

This study looked at adults with type 2 diabetes who had not previously used insulin. Researchers compared once-weekly insulin icodec with once-daily insulin degludec over 26 weeks.

The goal was simple: determine whether a weekly basal insulin could help control blood sugar as effectively as a daily basal insulin.

The results were encouraging.

Among adults with insulin-naïve type 2 diabetes, once-weekly insulin icodec showed a greater A1c reduction than once-daily insulin degludec after 26 weeks of treatment. In plain language, the weekly insulin option helped lower A1c at least as well as the daily insulin option, and in this trial, it performed slightly better.

That matters because A1c reduction is one of the main goals of diabetes treatment. For patients who need insulin but struggle with daily injections, a once-weekly option may help reduce one of the biggest practical barriers to treatment.

However, this does not mean Awiqli is risk-free. It is still insulin. It still requires careful dosing, glucose monitoring, patient education, and attention to hypoglycemia risk.

Safety Still Matters

Awiqli may reduce the number of injections, but it does not eliminate the risks that come with insulin therapy.

Hypoglycemia, or low blood sugar, remains an important concern. This is especially true when starting insulin, changing doses, switching from another insulin product, changing eating patterns, or adjusting other diabetes medications.

Patients should understand the signs of low blood sugar and know how to respond. Prescribers should also make sure patients understand that Awiqli is taken weekly, not daily.

That distinction is critical.

Because Awiqli is a once-weekly insulin, dosing errors can be serious. A patient should not accidentally take it like a daily insulin. They should also not confuse it with another injectable diabetes medication.

Clear instructions matter. So does follow-up.

Important Prescriber Note: Awiqli Is Concentrated

Prescribers should be especially careful with dosing.

Awiqli is concentrated at 700 units/mL, also known as U-700. That concentration can look unfamiliar compared with many commonly used insulin products.

For insulin-naïve patients, the recommended starting dose is 70 units once weekly. That weekly dose is equivalent to a typical starting basal insulin dose of about 10 units daily spread across the week.

That is an important point.

A 70-unit weekly dose may sound high at first, but it reflects the once-weekly dosing schedule. Prescribers and patients should understand that Awiqli dosing is not the same as daily basal insulin dosing.

Awiqli should be used only as directed, and patients should be trained on how to select and confirm the correct weekly dose.

What Patients Should Ask Their Provider

Patients should not start, stop, or switch insulin without medical guidance.

For adults with type 2 diabetes who are curious about Awiqli, helpful questions may include:

• Am I a candidate for once-weekly basal insulin?
• How would my dose be calculated?
• How often should I check my blood sugar when starting?
• What signs of hypoglycemia should I watch for?
• What should I do if I miss a dose?
• How does Awiqli fit with my current diabetes medications?
• What should I do if my meals, activity level, or routine changes?

The goal is not just fewer injections. The goal is safe, consistent, effective diabetes care.

The Bottom Line

Awiqli represents an important development in type 2 diabetes treatment.

Insulin remains one of the most effective therapies for lowering A1c, but many patients face real barriers to using it. Fear of needles, concern about hypoglycemia, weight gain, daily injection burden, and medication fatigue can all get in the way.

A once-weekly basal insulin may help reduce some of those barriers.

The ONWARDS 3 trial supports once-weekly insulin icodec as an effective option for A1c reduction in insulin-naïve adults with type 2 diabetes. The FDA-approved prescribing information also makes clear that Awiqli requires careful dosing, proper patient education, and close attention to hypoglycemia risk.

Awiqli may make insulin therapy feel more manageable for some adults with type 2 diabetes.

But the message for prescribers is just as important: slow down, verify the dose, educate the patient, and remember that weekly insulin dosing is different from daily insulin dosing.

Sources:
https://www.webmd.com/diabetes/awiqli-type-2-diabetes 
https://www.webmd.com/drugs/updates/awiqli-once-weekly-long-acting-basal-insulin-for-adults-with-type-2-diabetes
https://diatribe.org/diabetes-medications/fda-approves-once-weekly-basal-insulin-awiqli-type-2
https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/761326Orig2s000lbl.pdf