World First Once-Weekly Basal Insulin Awiqli

World First Once-Weekly Basal Insulin Awiqli

General Studies Paper II: Health

Why in News?

Recently, Novo Nordisk launched the world’s first once-weekly basal insulin, Awiqli (insulin icodec) in India, reducing annual injections dose.

What is Awiqli (Insulin Icodec)?

About: Awiqli is the world’s first once-weekly basal insulin containing insulin icodec, an ultra-long-acting insulin analogue for maintaining stable background insulin levels.
- Insulin icodec is a recombinant basal insulin analogue engineered with structural modifications that prolong its circulation, enabling one injection every seven days.
Objective: The primary objective is to provide effective basal glycaemic control, reduce physical injection pain without compromising efficacy.
Developed By: Awiqli was developed by Novo Nordisk.
- It is a Danish pharmaceutical company specializing in diabetes care and insulin innovation.
Features: Once-weekly dosing reduces injections from 365 to 52 annually.
- It is approved for clinical use in adults diagnosed with either Type 1 or Type 2 Diabetes Mellitus.
- Its plasma half-life exceeds eight days due to strong reversible albumin binding.
- It is supplied in prefilled injection pens with fixed weekly administration.
- It is administered by subcutaneous injection and is designed for adults requiring basal insulin therapy.
- It is man-made basal insulin analog engineered for a sustained 196-hour half-life.
- The ONWARDS Phase 3 programme demonstrated effective HbA1c reduction comparable or superior to daily basal insulin in many adults with Type 2 diabetes.
- It improved “Time in Range” compared to standard once-daily insulin glargine U100.
- It maintains a comparable safety profile to daily basal insulins without elevating the risk of severe hypoglycemia.
Mechanism of Action: Structural modifications, including a C20 fatty-diacid side chain and three amino-acid substitutions.
- It slow absorption and clearance through albumin binding, producing a stable basal insulin effect throughout the week.
- Novo Nordisk’s proprietary FlexTouch pre-filled pen features a unique internal spring mechanism that eliminates push-button extension during dosing.
- It is given under the skin of the abdomen, thigh or upper arm.
Launch Year: The medicine received European Union approval in 2024, Health Canada (2024), and US FDA approval on 26 March 2026.
- It was launched in India on 9 July 2026, making India one of its earliest launch markets.
- India became the seventh launch market, reflecting Novo Nordisk’s phased global commercialization strategy.
- India approved its use for both Type 1 and Type 2 diabetes, broader than the current US indication limited to Type 2 diabetes.
- The drug is priced competitively in India:
  - Per Unit Base Cost approximately ₹3.73 per unit.
  - 1 ml Pre-filled Pen contains 700 units and costs ₹2,611.
  - 3 ml High-Capacity Pen contains 2,100 units and costs ₹7,833.

Significance

Global Diabetes Burden: Diabetes affects approximately 589 million adults (20–79 years) worldwide in 2025, according to the International Diabetes Federation (IDF).
- Projections indicate this will increase to 853 million by 2050, highlighting the growing demand for innovative long-term insulin therapies.
India’s Diabetes Landscape: India has over 101 million people living with diabetes and nearly 136 million adults with prediabetes, making it one of the world’s largest diabetes populations.
- Around 6 million Indians currently require insulin therapy, with this number expected to reach 9 million in the coming years.
Regional Disease Prevalence: Clinical data highlights an urban diabetes prevalence rate of 15% to 20% across metro hubs, while rural vectors range from 8% to 12%.
- The most affected age bracket within the workforce falls between 45 and 59 years, directly impacting macroeconomic productivity.
Long-Term Treatment Adherence: Studies indicate that fear of injections, treatment fatigue and delayed insulin initiation remain major barriers.
- In India, insulin therapy is often postponed by 7–9 years after clinical need, making simplified treatment schedules an important advancement.
Burden of Chronic Therapy: Diabetes requires lifelong insulin administration for many patients.
- Weekly basal insulin reduces the frequency of routine injections, lowering treatment complexity while supporting sustained disease management.
Insulin Market Growth: India’s insulin market is projected to expand from US$660.5 million in 2025 to about US$916.4 million by 2034, driven by increasing diabetes prevalence and wider access to modern insulin therapies.
Pharmaceutical Innovation: Awiqli represents advances in protein engineering, drug-delivery technology, and long-acting biologics, opening pathways for future extended-duration medicines.
- The approval of weekly insulin in India is expected to accelerate research in ultra-long-acting insulin analogues, biosimilars and next-generation diabetes therapeutics.

IMPORTANT POINTS

Diabetes mellitus: It is a chronic metabolic disorder characterized by persistently high blood glucose (hyperglycaemia) due to inadequate insulin production, impaired insulin action, or both.
- Prolonged uncontrolled diabetes damages multiple organs, especially the heart, kidneys, eyes, nerves, and blood vessels.
Types: The major forms are Type 1 Diabetes, Type 2 Diabetes, Gestational Diabetes Mellitus (GDM), and other specific forms caused by genetic disorders, pancreatic diseases, or medicines.
- Type 2 accounts for about 90% of all diabetes cases globally.
Causes: Major risk factors include obesity, physical inactivity, unhealthy diet, advancing age, family history, hypertension, dyslipidaemia, and previous gestational diabetes.
- Type 1 diabetes primarily results from autoimmune destruction of pancreatic β-cells.
Symptoms: Common symptoms include polyuria, polydipsia, unexplained weight loss, fatigue, and blurred vision.
- Persistent hyperglycaemia can cause cardiovascular disease, stroke, chronic kidney disease, retinopathy, neuropathy, diabetic foot ulcers, and lower-limb amputations.
Diagnosis: It relies on fasting plasma glucose, HbA1c, oral glucose tolerance test (OGTT), or random blood glucose testing.
Prevention: Effective control combines healthy diet, regular physical activity, weight management, tobacco avoidance, periodic monitoring, oral antidiabetic medicines, and insulin therapy.
Initiatives: Diabetes is addressed under the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) through screening, early diagnosis, treatment, and health promotion at Ayushman Arogya Mandirs.

FAQs:

1. What is Once-Weekly Insulin Awiqli?
Awiqli is the world’s first once-weekly basal insulin (insulin icodec) for long-term blood glucose control in adults with diabetes.

2. Why is Awiqli considered a breakthrough in diabetes treatment?
It reduces 365 annual injections to 52 while providing sustained basal insulin with comparable glycaemic control.

3. How does once-weekly insulin differ from daily insulin?
It requires one injection every seven days instead of daily dosing through an ultra-long-acting insulin formulation.

4. Who can use Awiqli insulin?
It is intended for adults requiring basal insulin therapy, as prescribed by healthcare professionals.

5. Is Awiqli approved for both Type 1 and Type 2 diabetes?
In India, yes; in the United States, currently only for adults with Type 2 diabetes.

6. What are the benefits of once-weekly insulin therapy?
It simplifies treatment, reduces injection burden, and may improve adherence while maintaining effective blood glucose control.

7. How does Awiqli help improve diabetes management?
It provides stable seven-day basal insulin coverage, supporting consistent glucose control with fewer scheduled injections.

8. Who developed Awiqli insulin?
Novo Nordisk, the Denmark-based global pharmaceutical company, developed Awiqli (insulin icodec).

9. Is Awiqli available in India?
Yes. Awiqli was commercially launched in India on 9 July 2026 and became available from 10 July 2026.

Disclaimer: Information in this article is based on official announcements and public records. Regulations and implementation details may evolve over time.