The news: Eli Lilly’s once-weekly insulin Onswik was approved by the FDA for adults with type 2 diabetes. It’s the second once-weekly insulin approved in the US, following Novo’s Awiqli in March.

Why it matters: Weekly dosing could make insulin more convenient for people with type 2 diabetes, cutting basal injections from about 365 a year to 52.

Weekly insulin dosages could also reduce three key barriers to starting or staying on treatment.

• The burden of daily injections. In Lilly clinical trials, patients reported greater improvements in how much treatment interrupts daily life and satisfaction with efsitora (now Onswik) compared with daily basal injections, per Diabetes Therapy.
• Adherence. Patients on efsitora in the same study reported improvements in treatment compliance than those on daily insulin.
• Getting started. Some type 2 diabetes patients delay starting insulin in part because of concerns about daily injections interfering with their lives per the American Diabetes Association.

Implications for insulin drugmakers: Weekly insulin gives Lilly and Novo a chance to switch patients who take their competitors’ daily products, including Sanofi’s Lantus and Toujeo and biosimilars. They may also reach people with type 2 diabetes who have avoided daily insulin shots because of the burden.

Messaging around once-weekly convenience can give patients a reason to talk to their providers about starting or switching insulin. Supporting that transition will also require clear dosing and monitoring guidance for patients and HCPs, particularly during the first weeks of treatment.

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