Once-weekly insulin approved in UK for type 2 diabetes in adults

The Medicines and Healthcare products Regulatory Agency (MHRA) authorised Onswik (insulin efsitora alfa) on 13 October 2026 for adults with type 2 diabetes. It is a long-acting basal insulin injected once a week.

For people who need basal insulin, that could mean 52 injections a year in place of up to 365, as the MHRA put it. NICE had already backed the drug in final draft guidance in August, subject to the licence, and published final guidance days after the MHRA decision. That means the NHS in England must fund it within 90 days for people for whom it is the most suitable option.

The trial evidence shows efsitora controls blood sugar about as well as daily insulin. The case for it rests on convenience and on cutting the workload of helping people inject, more than on better control.

What was approved

According to the MHRA:

The NICE committee papers describe two pen strengths, 500 units/mL and 1,000 units/mL, and two ways to start for people new to insulin: a fixed-dose schedule that steps up from 100 units a week, and a flexible schedule with a one-off larger starting dose.

Julian Beach, MHRA Executive Director of Healthcare Quality and Access, said: "Clinical trial data showed that once-weekly insulin efsitora alfa provided glycaemic control comparable to once-daily basal insulin treatments in adults with type 2 diabetes."

How a weekly insulin works

Basal insulin provides a steady background level of insulin between meals and overnight. Standard basal insulins such as glargine and degludec are injected once or twice a day.

The NICE committee papers explain why efsitora lasts so much longer. It is a large molecule that the kidneys clear slowly. It binds the neonatal Fc receptor, which recycles it back into the blood. It also grips the insulin receptor less tightly. So less is removed that way. Together these create a reservoir of insulin that is released steadily over the week.

The QWINT trials

Lilly tested efsitora in the QWINT phase 3 programme. NICE's committee papers summarise four open-label randomised trials that matter for the UK decision:

The trials were designed to show non-inferiority: that efsitora is not meaningfully worse than daily insulin at lowering HbA1c, a measure of average blood sugar over about three months.

What the trials found

The published results for three of the trials report:

NICE's summary is that efsitora is as effective at controlling blood sugar as degludec and glargine over 26 to 52 weeks. The hypoglycaemia picture is mixed across trials: lower than glargine in QWINT-1, slightly higher than degludec in QWINT-2 and QWINT-3. Low blood sugar remains the main risk, as with any insulin.

Why NICE said yes

NICE recommends efsitora as an option within its licence for adults with type 2 diabetes. It also tells clinicians to use the least expensive suitable option, taking account of administration costs, dosing, price per dose and commercial arrangements.

The committee found the biggest cost saving comes from people needing less help to take their insulin. Some people rely on district nurses to give daily injections. NICE assumed an average of an hour of a specialist district nurse's time each time a person needs help. Moving to one injection a week could free up a large share of those visits.

NICE says once-weekly insulin may particularly help people who:

• need help to take insulin or extra support to stick to treatment, for example because they are frail, have a learning disability, have problems with manual dexterity, or have a visual, cognitive or sensory impairment
• find daily insulin hard, for example people of working age with early-onset type 2 diabetes

The uncertainty NICE flagged

NICE was candid about the gaps. The people most likely to benefit, such as those who need help injecting, were underrepresented in the trials. That adds uncertainty about how well the results apply to them, though NICE judged that the evidence still applies to NHS patients overall.

The committee also noted that the amount of help people need varies, and that the cost model had not fully explored different scenarios. The real-world savings could be larger or smaller than modelled.

Price and access in the UK

NICE did not publish a list price in the recommendation, and we have not found one. Funding must be in place within 90 days of the final guidance, which NICE published on 16 October 2026. The guidance covers England. Scotland and Wales make their own arrangements.

What changes for patients

For someone already on daily basal insulin, switching is not automatic. The proposed dosing in the NICE committee papers includes advice on when a one-off starting dose is used and warns that blood sugar may run high for a while if it is not. Moving from a daily insulin also needs a plan for the first weeks, and people need to keep checking blood glucose.

Practical questions to raise with a GP or diabetes nurse include:

• whether a weekly insulin suits your routine and support needs
• how hypoglycaemia would be spotted and managed with a longer-acting insulin
• what happens if you miss a weekly dose
• whether you would still need mealtime insulin

Other weekly insulins

Efsitora is not the first weekly basal insulin to reach Europe. Novo Nordisk's insulin icodec (Awiqli) was authorised in the EU in 2024. The efsitora decision gives prescribers a second option and adds competition, which may affect the price the NHS pays.

Anyone interested should discuss it with their diabetes team and not stop their current insulin on their own.

This article explains published research and isn't medical advice. Talk to your own doctor or specialist team before changing any treatment.