The National Institute for Health and Care Excellence (NICE) has recommended once-weekly insulin efsitora alfa (Onswik, Eli Lilly) as a new treatment option for adults with type 2 diabetes, subject to marketing authorisation from the Medicines and Healthcare products Regulatory Agency (MHRA). 

In final draft guidance, NICE said the once-weekly injection could cut the number of annual insulin injections from 365 to 52 for people switching from a daily basal insulin regimen — an 85% reduction. 

Insulin efsitora alfa can be used alone or alongside other treatments for type 2 diabetes and is administered once weekly as a subcutaneous injection using a pre-filled pen.

Who Could Benefit Most 

Type 2 diabetes is a common condition in which the body does not make enough insulin or the insulin it produces does not work properly because of insulin resistance. Insulin helps the body use glucose for energy, and without sufficient insulin, blood glucose levels become too high. There were 4.6 million people in the UK with diagnosed diabetes in 2023-2024, of whom approximately 90% had type 2 diabetes. 

The weekly injection may particularly benefit patients who need help administering insulin, including those who are frail; have learning disabilities; experience problems with manual dexterity; or have visual, cognitive, or sensory impairments. It may also suit some people with early-onset type 2 diabetes who are balancing intensive treatment with working life, as well as those who struggle to adhere to a daily regimen. For this group, the weekly schedule could also mean fewer visits from carers or healthcare professionals and less disruption to everyday life.

"Moving from daily injections to a single weekly dose could make a real difference to the day-to-day lives of people with type 2 diabetes, especially those who rely on a carer, family member or healthcare professional to help them inject,” said Helen Knight, director of medicines evaluation at NICE. “This recommendation is the result of rigorous, evidence-based decision making, striking a balance between the benefits to patients and the best use of limited NHS funding,” she added.

Douglas Twenefour, head of clinical at Diabetes UK, said the recommendation could give some people with type 2 diabetes greater flexibility in how their condition is managed, particularly those with additional care needs. “Any NHS rollout should be supported by clear guidance, staff training and fair access. It's essential that everyone who could benefit is supported by their healthcare team to make informed decisions, and that this treatment helps reduce inequities in diabetes care,” he added.

Clinical Evidence

Three phase 3 QWINT trials supported the efficacy and safety of once-weekly insulin efsitora alfa across different treatment settings. 

In QWINT-1, 795 insulin-naive adults with type 2 diabetes were randomly assigned to receive fixed-dose weekly efsitora or daily insulin glargine U100 for 52 weeks. A1c fell by 1.19 percentage points with efsitora vs 1.16 percentage points with glargine, demonstrating non-inferiority. Clinically significant or severe hypoglycaemia was less frequent with efsitora (0.50 vs 0.88 event per participant-year), while patients required fewer dose adjustments (median, 2 vs 8). 

In QWINT-3, 986 adults with type 2 diabetes already receiving basal insulin were randomised 2:1 to weekly efsitora or daily insulin degludec for 78 weeks. At week 26, A1c decreased by 0.81 percentage point with efsitora vs 0.72 percentage point with degludec, again demonstrating non-inferiority. Rates of combined level 2 or level 3 hypoglycaemia were similar over 78 weeks (0.84 vs 0.74 event per patient-year).

QWINT-4 evaluated 730 adults receiving basal and prandial insulin, who were randomised to weekly efsitora or daily glargine U100, both with prandial insulin lispro, for 26 weeks. A1c decreased by 1.01 percentage points with efsitora and 1.00 percentage point with glargine, confirming non-inferiority. Rates of overall and nocturnal level 2 or level 3 hypoglycaemia and adverse events were similar between groups.

NICE said trial evidence showed once-weekly insulin efsitora alfa provided blood glucose control comparable to insulin degludec and insulin glargine, although people most likely to benefit were underrepresented in the studies.

Cost, Access, and Timeline 

NICE's cost comparison suggested that overall costs for insulin efsitora alfa were similar to or lower than those for basal insulin intended for administration once or twice a day, particularly where people need support to take insulin. The largest potential savings were associated with patients who require help administering insulin, because weekly dosing could reduce healthcare professional visits.

NICE's final draft guidance recommends that healthcare professionals and patients discuss the benefits and disadvantages of suitable treatment options and select the least expensive option that meets the individual's needs. Decisions should consider factors including dosage, administration costs, and treatment price per dose, as well as commercial arrangements.

If final guidance is published after MHRA marketing authorisation, NHS England will be required to fund the treatment within 90 days. The final draft guidance is now open to appeal and, barring an appeal, is expected to be finalised on 10 September 2026.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.