Contributor: Airam Viennelu Aliwalas, PharmD Candidate Class of 2027, PCOM School of Pharmacy
AP is a 44-year-old female with past medical history of type 2 diabetes mellitus. She presents to the clinic for her 6-month follow-up. Her current regimen involves insulin glargine (Lantus) every night before bed, but she admits she occasionally misses a dose if she’s tired from a long day at work. During today’s visit, her HbA1c is at 7.2% and she is requesting whether there is a regimen that requires less frequent dosing but still controls her blood glucose levels.
Basal insulin therapy in patients with diabetes mellitus is initiated when non-insulin diabetes medications cannot effectively lower blood glucose levels. This regimen involves a long-acting insulin typically dosed once daily sometimes twice daily. This once-daily regimen can increase treatment burden for some patients, affecting medication adherence. With the approval of a once-weekly dosing insulin regimen, these barriers can be addressed.
In March 2026, the U.S. Food and Drug Administration (FDA) approved insulin icodec-abae (Awiqli®) as the first once-weekly basal insulin indicated for adults with type 2 diabetes mellitus. Insulin icodec-abae is a long-acting insulin analog with a half-life of approximately 196 hours, allowing for once-weekly dosing. Its prolonged duration of action is due to its property of binding to albumin, allowing gradual release of insulin throughout the week, which can potentially improve medication adherence. The ONWARDS phase III clinical program compared insulin icodec-abae to insulin glargine and insulin degludec in persons with diabetes mellitus. Across multiple phase III trials, insulin icodec-abae demonstrated noninferior glycemic control and greater reductions in HbA1c compared with the once-daily basal insulins while maintaining a similar safety profile.
Insulin icodec-abae (Awiqli®) Quick Facts
| FDA Approval Date and Indication | March 2026 Adults with type 2 diabetes mellitus as an adjunct to diet and exercise |
| Class | Long-acting basal insulin analog |
| Half-life | Approximately 196 hours |
| Administration | Subcutaneous injection once weekly |
| Dosing | Persons not currently on basal insulin: 70 units once weekly Transition from once-daily basal insulin: Week 1: Recommended dose is 1.5 times the total daily basal dose multiplied by 7 rounded to the nearest 10 units Week 2: Multiply the previous total daily dose of the other basal insulin by 7 and round to the nearest 10 units Week 3 and onward: Titrate from previous week’s dose based on person’s glycemic needs Example Weekly Dosage: -Previous total daily dose of basal insulin 10 units — week 1 dosage 110 units — week 2 dosage 70 units Initial dose adjustments in renal dysfunction: -eGFR 10 – 40 mL/min: administer 75% of starting dose -eGFR < 10 mL/min: administer 50% of starting dose Close glucose monitoring is needed |
| Available pens | U-700 prefilled FlexTouch® pen 1 mL (700 units 1.5 mL (1050 units) 3.0 mL (2100 units) |
Following AP’s concern with a few missed insulin doses, her team suggested switching to once-weekly insulin icodec-abae to accommodate her busy work schedule. She was counseled on the transition from once-daily basal insulin to once-weekly dosing, which involves a 3-week transition dosing schedule. At her 3-month follow-up after switching regimens, her HbA1c had improved to 6.8%, achieving her goal of <7%. She reported missing fewer doses and expressed that this regimen was easier to incorporate into her schedule.
References
Ahmed M, Shafiq A, Javaid H, et al. Clinical Outcomes With Once‐Weekly Insulin Icodec Versus Once‐Daily Insulin Glargine U100 in Insulin‐Naïve and Previously Insulin‐Treated Individuals With Type 2 Diabetes: A Meta‐Analysis of Randomised Controlled Trials. Endocrinology, Diabetes & Metabolism. 2024;7(3). doi:10.1002/edm2.480
Bajaj HS, Goldenberg RM. Insulin Icodec Weekly: A Basal Insulin Analogue for Type 2 Diabetes. European Endocrinology. 2023;19(1):4. doi:10.17925/ee.2023.19.1.4
Insulin icodec. In: Lexi-Drugs [database online]. UpToDate Lexidrug. UpToDate, Inc; 2026.. https://online.lexi.com
Once-Weekly Long-Acting Insulin | Awiqli® (Insulin Icodec) Injection 700 U/mL; 2026. https://www.awiqli.com/.
Philis-Tsimikas A, Aberle J, Bajaj H, et al. Clinical Use of Once-Weekly Insulin Icodec: Translating Clinical Trial Data into Practical Guidance for Diabetes Management. Drugs. 2025;85(10):1253-1268. doi:10.1007/s40265-025-02201-0