New Delhi: With the introduction of Awiqli, a once-weekly basal insulin injection from Novo Nordisk, diabetes care in India has entered a new era. Its generic name is insulin icodec — a new glucose-lowering medicine that aims to replace the need for an injection of long-acting insulin once a day by administering one dose every seven days in suitable adult patients with Type 1 or Type 2 diabetes.
The therapy when launched, could potentially reduce the 365 basal insulin injections to just 52 annually which enables some patients with injection fatigue or fear of needles or those on complex medication regimens to have less difficulty with treatment.
How weekly insulin works
Basal insulin creates the scheduled background dose of insulin that the body requires to keep blood glucose between meals and throughout sleep under control. Conventional basal insulin is usually dosed once a day while insulin icodec has been designed to last for an entire week.
Awiqli is a subcutaneous injection via a pre-filled FlexTouch pen. Patients are supposed to give the injection 7 days a week at the same time each week, with dosing decided and adjusted by their physician based on blood glucose values since diagnosis and existing insulin usage and treatment plan.
This weekly medicine should not be started on your own or as a substitute for daily insulin without the supervision of a healthcare professional. Correct dosing and monitoring is more important due to the larger amount of insulin given at one time.
Approved for adult patients
About AwiqliDiabetes management continues to be a significant challenge, and Awiqli has been launched in India to serve as medication for adults with Type 1 and Type 2 diabetes requiring basal insulin. In case of type 2 diabetes, you might consider it if blood sugar control continues to be inadequate regardless of oral medicines or other medicines.
For people aged 18 and over, the medication might be used as background insulin for Type 1 diabetes. However, many Type 1 diabetes patients will continue to need rapid-acting or mealtime insulin for the management of postprandial glucose elevations. Just one weekly injection does not eclipse all forms of insulin treatment.
The final treatment choice depends on factors such as:
- Diabetes type.
- Current insulin regimen.
- HbA1c and daily glucose readings.
- Kidney and liver health.
- Risk of hypoglycaemia.
- Meal-time insulin requirements.
- Ability to follow a weekly dosing schedule.
Cost and availability
Awiqli is positioned at an indicative weekly cost of ₹261 per week for a 70-unit dose, said the company. It will come in pre-filled pens of 700 units and 2,100 units. The 700-unit pen is available for about ₹2,611 while the 2,100-unit pen can be purchased for about ₹7,883.
Of course, the monthly price will depend on the dose prescribed to the patient. An individual who should be taking around 70 units in a week might shell out ₹1,045 per month solely for the drug (other than doctor consultations, glucose monitoring, other types of insulin and additional diabetes medicines that add to the treatment cost).
Launch: The product will be marketed by a national chain of pharmacies and distributors. Cities, hospitals and retail outlets might have different initial availability of the drug.
Potential benefits for patients
The most immediate benefit is the reduction in injection frequency. Moving from a daily basal injection to a weekly dose may reduce treatment fatigue and make insulin therapy more convenient for some patients.
Potential advantages include:
- Fewer injections each year.
- Simpler basal insulin routines.
- Possible improvement in adherence.
- Reduced anxiety among people who fear daily injections.
- Greater convenience for patients and caregivers.
- Easier medication planning during travel or busy work schedules.
Treatment adherence is a significant challenge in diabetes management. Some patients delay starting insulin or miss doses because of discomfort, inconvenience or concerns about long-term injections. A weekly option may help address some of these barriers.
Evidence from clinical studies
Insulin icodec was approved and launched after evaluation in the ONWARDS clinical trial programme exploring its use for diverse people with diabetes. The results from the trials suggested that once-weekly insulin was equivalent to or in some studies superior to specific daily insulin doses in glycaemic control.
HbA1c and time in range improvements compared with some once-daily insulin therapies have also been described in clinical reports. The former (HbA1c) reflect the average blood glucose for about 2–3 months, while the latter (time in range) reflects how long the glucose is at target range.
Of course, all data from clinical trials vary from individual to individual. Weekly injections will not necessarily achieve a better control without adequate management of diet, diabetes-derived glucose monitoring, appropriate physical activity and regular medical follow-up.
Important safety considerations
Driving risk: Insulin can cause hypoglycaemia or dangerously low blood sugar, if too much is taken and even just with normal doses of insulin- meals are missed or there is an unexpected increase in physical activity. Some will get sweating, shakiness, hunger as well as dizziness, confusion and weakness in addition to heart racing.
Since the duration of action of insulin icodec is greater than a single day, we expect that a dosing error could have longer consequences than those associated with some daily insulin products. Therefore, patients must adhere closely to the prescribed dose and contact their physician if they accidentally inject too much or miss a scheduled dose.
If a patient has just started or switched to weekly insulin, it may be necessary for doctors to recommend closer glucose monitoring. Patients should also be taught to identify and treat hypoglycemia, and to maintain a readily available source of glucose with fast acting source when directed.
Weekly insulin does not end daily diabetes care
While you only get an injection once weekly, diabetes management is a daily affair. The patient may still have to monitor their glucose, comply with meal and exercise recommendations, consume oral psychotropic agents and injectable mealtime medicines if indicated.
This is a basal insulin, not a silver bullet for diabetes. Most people with Type 1 diabetes take a combination of background and mealtime insulin and some persons with Type 2 diabetes may require additional medications to achieve glucose targets based on their treatment goals.
Check-ups with regards to blood pressure, kidney function, cholesterol, eye health, foot health and other diabetes-related risks need not be neglected.
Could improve insulin acceptance
Fear of needles, unsubstantiated beliefs about the role of insulin in diabetes management and fears of complexity of injections all lead to delays in starting insulin. A once-a-week option might make some patients more likely to start insulin when advised by their physicians.
And the less frequent injections may also aid caregivers who provide insulin to older adults or those with limited mobility. Still, the treatment needs to be stored correctly, pens used appropriately, doses tracked and follow-up should happen reliably.
Healthcare professionals will have an important role in explaining who might benefit from weekly insulin and Patients need to be aware that missing a weekly dose can impact glucose control for days.
Questions about access and affordability
Although the launch itself is noteworthy, availability will hinge on price, insurance coverage and physician uptake. Although the weekly cost (see below) may be more affordable than some other daily insulin analogues, for patients who also need mealtime insulin, glucose-monitoring supplies or other medicines, it could still end up being a large financial burden.
Public health care programs, private insurers and hospitals, however, will have to define if–or how–the product is covered. Less expensive alternatives with wider availability may also determine the options available in India and therefore how quickly over the course of a week insulin can be adopted.
A major change in diabetes treatment
Awiqli provides an option for basal insulin replacement to adults in India who are eligible for treatment. With 52 injections to get in a year instead of 365, it could help make insulin treatment more convenient — and enable some patients to adhere to the prescribed regimen.
Nonetheless, the drug is not for all individuals and should be taken under clinical direction. Patients should be referred to a diabetologist before switching from daily insulin, changing the dose or administer weekly injection with any other product insulin.