Adapted from BMJ 11 Oct 2025
Insulin is often prescribed for type two diabetes patients who need extra help with blood sugar control. Up until now, this has been injected once or twice a day. Patients are often reluctant to start insulin, however, due to concerns about the injections, dose adjustment and worries about hypoglycaemia. Once weekly insulin may be an attractive proposition for some patients.
Once weekly insulin has already been developed and has been shown to be no worse than insulin glargine or degludec. Due to potential hypoglycaemia, weekly insulin could be a problem, especially for type one patients. Nonetheless once weekly icodec has been approved for use in adults with diabetes in the Europe and Canada but it has been rejected in the US.
In trials of type two patients, once weekly insulin, used as a basal insulin, was popular with the patients, and the rates of severe hypoglycaemia were not different from those using other types of basal insulin.
Titrating up the dose in type two patients takes about 8 to 12 weeks, because the doses must be titrated cautiously. It is thought that people who are prone to experiencing ketoacidosis due to missed insulin doses, may have a lot to gain with a weekly schedule. Those who are aiming for looser blood sugar control, those with co-morbidities, and those whose insulin needs to be administered by a care giver also may benefit.
Neither insulin icodec or efsitora, the weekly insulins, are yet licenced for use in the UK at the current time. NICE will be examining the evidence and trying to determine what the place of weekly insulin should be in the NHS.
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