Once-Weekly Insulin Icodec Offers a Major Shift in Type 2 Diabetes Care

The recent FDA approval and US availability of insulin icodec (Awiqli, Novo Nordisk) marks a major shift in how clinicians can approach insulin therapy for type 2 diabetes, Rachael Sood, NP-C, CDCES, founder and chief executive officer of the Diabetes Collective, told Patient Care Online in a new interview. For patients who struggle to remember a daily injection — whether due to routine disruptions, cognitive load, or simple pill fatigue — a once-weekly regimen removes a significant point of friction. She called the development "a huge deal" for adults with type 2 diabetes who require insulin on an ongoing basis.

That convenience is especially relevant for older adults, Sood said, particularly those managing memory conditions such as dementia or Alzheimer's, or who rely on caregivers for medication administration. She compared the once-a-week routine to how many patients already track GLP-1 receptor agonist dosing: mark a single day on the calendar and administer. But she cautioned that the same durability that makes weekly dosing convenient also raises the stakes if a patient's condition changes mid-week — once a full week's dose has been given, it can't be withdrawn, so illness, dehydration, or reduced appetite could leave more insulin on board than a patient currently needs.

Sood also flagged that dosing math looks different from what most clinicians are used to. Standard once-daily basal insulin typically starts around 0.1 to 0.2 units per kilogram of body weight; once-weekly dosing follows similar weight-based logic but at roughly double the number. As an example, she noted that a patient started on 10 units of insulin glargine daily might begin closer to 70 units once weekly — numbers she said can look intimidating without that context. She emphasized confirming the dose against each patient's glucose trends, weight, and insulin history rather than defaulting to a standard starting number.

Sood has no relevant disclosures to report.

References:

1. Novo Nordisk. FDA approves Novo Nordisk's Awiqli®, the first and only once-weekly basal insulin treatment for adults with type 2 diabetes. News release. March 26, 2026. Accessed August 18, 2026. https://www.prnewswire.com/news-releases/fda-approves-novo-nordisks-awiqli-the-first-and-only-once-weekly-basal-insulin-treatment-for-adults-with-type-2-diabetes-302726839.html
2. Novo Nordisk. Novo Nordisk's Awiqli®, the first once-weekly basal insulin for adults with type 2 diabetes, now available in the US. News release. August 11, 2026. Accessed August 18, 2026. https://www.prnewswire.com/news-releases/novo-nordisks-awiqli-the-first-once-weekly-basal-insulin-for-adults-with-type-2-diabetes-now-available-in-the-us-302847645.html
3. Awiqli (insulin icodec-abae) injection, for subcutaneous use [prescribing information]. Plainsboro, NJ: Novo Nordisk Inc; 2026. Accessed August 18, 2026. https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/761326Orig2s000lbl.pdf