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Novo Nordisk's once-weekly basal insulin icodec-abae (Awiqli) injection of 700 units/mL is now available in US pharmacies nationwide.
It is the first once-weekly basal insulin in the US, approved in March 2026 by the FDA as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes (T2D). It is available in one concentration, U-700, delivered with a FlexTouch pen.
The approval was based on data from Novo Nordisk's four phase 3 ONWARDS trials, involving a total of 2680 adults with T2D not well controlled with other agents, comparing once-weekly icodec with daily basal insulin in combination with either mealtime insulin, a GLP-1 receptor agonist, or oral glucose-lowering drugs. These trials all showed either noninferiority or superiority of the once-weekly with the daily basal in glucose lowering.
The FDA had initially issued the company a " complete response letter" in July 2024 to its first biologic license application for icodec for use in people with both major diabetes types, in part due to concerns regarding hypoglycemia risk in type 1 diabetes (T1D). In May 2024, an FDA advisory panel voted against its use in T1D while expressing no safety concerns about its use in T2D.
Novo Nordisk's Patient Education Center offers resources including a program capping out-of-pocket costs to as little as $35 per month for those who qualify.
The product is also available in the EU and 13 other countries, including Canada, Australia, and Japan.
Miriam E. Tucker is a freelance journalist based in the Washington DC area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR's Shots blog, and Diatribe. She is on X (formerly Twitter) @MiriamETucker and BlueSky @miriametucker.bsky.social
