Danish pharmaceutical company Novo Nordisk on Wednesday launched Awiqli (insulin icodec), the world's first once-weekly basal insulin for adults with Type 1 and Type 2 diabetes. The new therapy marks a significant advancement in diabetes management by reducing the number of basal insulin injections from 365 per year to just 52.
Insulin is a hormone that enables glucose (sugar) to move from the bloodstream into the body's cells, preventing excessive sugar levels in the blood. People with Type 1 diabetes and those with advanced Type 2 diabetes require insulin therapy—typically administered once daily, and in some cases multiple times a day—to maintain healthy blood glucose levels.
Novo Nordisk, which also manufactures the widely used diabetes and obesity drug semaglutide, said the new treatment aims to address one of the biggest obstacles to insulin adoption in India: the fear of daily injections. According to the company, this fear often delays the initiation of insulin therapy by an average of seven to nine years.
A 700-unit pack of Awiqli has been priced at Rs 2,611, translating to approximately Rs 3.73 per unit. The company said this makes it around 30–40 per cent cheaper per unit than many currently available daily basal insulin options.
Patients beginning insulin therapy often require around 10 units of insulin per day. Such patients would need approximately 70 units of Awiqli each week, resulting in a weekly treatment cost of about Rs 261.
The pricing has surprised many clinicians.
"The biggest surprise is Awiqli's launch at a highly competitive price, close to existing daily basal insulin, making this innovation accessible rather than exclusive," said Mumbai-based metabolic disease specialist and diabetologist Dr Rajiv Kovil.
He added that clinical trials demonstrated glycaemic control that was comparable to, and in several cases better than, daily basal insulin, provided appropriate dose titration was followed.
India is home to an estimated 10.1 crore people living with diabetes and another 13.6 crore with prediabetes. The country also has more than 9 lakh people with Type 1 diabetes, an autoimmune condition in which insulin therapy remains the cornerstone of treatment.
Around 10 per cent of people with Type 2 diabetes—which develops primarily because the body becomes resistant to insulin or cannot use it effectively—also require insulin therapy.
Novo Nordisk currently manufactures four of India's five best-selling insulin brands, including Mixtard and Ryzodeg, and distributes these products in partnership with Abbott.
Reducing the treatment burden
Unlike conventional basal insulin, which must be injected every day, Awiqli is administered once a week using the FlexTouch pen device. The company said the simplified dosing schedule could improve treatment adherence and encourage patients who are reluctant to begin insulin therapy to start treatment earlier.
The launch comes at a time when India continues to face one of the world's highest diabetes burdens. Recent data from the National Family Health Survey (NFHS-6) also indicates a significant rise in the prevalence of high blood sugar across both urban and rural populations.
Clinical findings from the ONWARDS-1 programme showed that Awiqli achieved greater reductions in HbA1c—a key indicator of long-term blood glucose control—and improved "time in range" compared with once-daily insulin glargine U100, while maintaining a similar safety profile.
According to Novo Nordisk, a higher proportion of patients with Type 2 diabetes achieved HbA1c levels below 7 per cent without experiencing hypoglycaemia.
Vikrant Shrotriya, Managing Director of Novo Nordisk India, described the launch as "a defining moment" for diabetes care in the country, saying that once-weekly dosing could reduce both the psychological and physical barriers associated with insulin therapy.
Addressing India's unmet need
Endocrinologist Dr S.K. Wangnoo of Indraprastha Apollo Hospital in New Delhi said delayed initiation of insulin therapy and poor adherence continue to affect diabetes outcomes. He noted that innovations simplifying treatment could improve patient acceptance and encourage earlier intervention.
In India, physicians often face challenges related to treatment adherence, while many patients delay insulin because of concerns over injections, pain and the complexity of therapy. A once-weekly insulin option could help address these long-standing barriers to effective diabetes management.
A nationwide study funded by the Indian Council of Medical Research (ICMR) and coordinated by the Madras Diabetes Research Foundation, published in 2022, found that only one in three people with known diabetes had their condition under adequate control.
Shrotriya said that around 60 lakh people in India are currently using insulin, while at least twice that number are likely to require it.
"If we can increase that number to even 90 lakh, it will be a major success for Awiqli, both in addressing the large unmet need and from a commercial perspective," he said.
Novo Nordisk currently offers around 20 different insulin products, and according to Shrotriya, every second person using insulin in India relies on a Novo Nordisk brand.
