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From up to 365 injections a year to 52: the UK approves a weekly insulin

Qurexa Editorial Team18 October 20267 min read 0 0
From up to 365 injections a year to 52: the UK approves a weekly insulin

What happened

On 13 October 2026, the MHRA authorised a new insulin for adults with type 2 diabetes in the UK. Its brand name is Onswik, and the medicine itself is called insulin efsitora alfa. The point of it is simple. It is a long-acting basal insulin given as one injection a week, instead of one a day. The MHRA put the difference in plain numbers. For some adults, this could cut injections from up to 365 a year down to 52. Julian Beach, the MHRA's Executive Director of Healthcare Quality and Access, said the decision "follows a rigorous assessment of the available evidence", and that clinical trial data showed the once-weekly insulin "provided glycaemic control comparable" to a once-daily basal insulin. Glycaemic control means how steadily blood sugar is kept in a healthy range. He added: "As with all medicines, we will continue to monitor its safety closely through our established surveillance systems." The marketing authorisation holder is Eli Lilly Nederland B.V., and the approval came through the ACCESS procedure, a route the UK shares with regulators in Australia, Canada, Singapore and Switzerland. NICE, which decides what the NHS should pay for, had already recommended insulin efsitora alfa for certain adults in final draft guidance published on 20 August 2026. That recommendation was conditional on the medicine being licensed in the UK. It now is.

Why this matters

Around four in five people with diabetes in the UK have type 2. Most are managed with tablets, diet and other injectable medicines. But a good number eventually need basal insulin, which is a slow, steady background insulin that works through the day and night. Daily injections are not difficult, exactly. They are relentless. Doing something every single day, for years, without missing one, is a genuinely hard ask of anybody. It is harder still if you have poor eyesight, shaky hands, arthritis, a memory problem, or a job that moves you around. This is where a weekly injection could change things. Fifty-two decisions a year is a very different burden from 365. It also makes help easier to arrange. If someone needs a district nurse or a family member to give the injection, a weekly visit is far more practical to organise than a daily one. There is a wider reason this matters as well. Some people delay starting insulin for a long time, sometimes years, because of how daunting daily injections feel. If the choice is weekly rather than daily, that conversation with a diabetes nurse may feel less like a door closing.

What the evidence actually says

Here is where it pays to read the regulator's own words closely rather than the headlines. The MHRA says the trial data showed blood glucose control "comparable" to once-daily basal insulin. Comparable means about as good. It does not mean better. The announcement makes no claim that this insulin controls blood sugar more effectively than what people use now. Its advantage is convenience, not superior results. The MHRA's release also gives no trial sizes and no numerical results. So anyone quoting precise percentages for this medicine is drawing on the published trial papers, not on this authorisation. On safety, the most common adverse reaction listed is hypoglycaemia, meaning low blood sugar. That is the familiar risk with any insulin, and it is not unique to this one. It does mean people and their families still need to know the signs of a low: shaking, sweating, confusion, hunger, feeling faint. There is also an open question about who actually gets it. The MHRA licence says what the medicine may be used for. NICE's recommendation, from its 20 August 2026 final draft guidance, is for certain adults rather than everyone with type 2 diabetes. Local NHS prescribing lists then decide what is routinely available in a given area. So this will not appear in everyone's repeat prescription next month. Finally, the detailed documents, the Summary of Product Characteristics and the Patient Information Leaflet, were to be published later on the MHRA Products website. Those are the papers that will carry the dosing detail.

Qurexa perspective

Medication adherence support is a large part of what we do, so this is a story we have an honest stake in. Adherence is a dull word for something very human: whether a medicine actually gets taken, on time, in real life. In our experience, the single biggest predictor is not how motivated someone is. It is how many times a day the medicine asks something of them. A weekly insulin does not solve everything. It introduces a different problem, which is remembering one important thing a week rather than one routine thing a day. People who have never missed a daily dose because it is tied to brushing their teeth may find a weekly rhythm harder, not easier, at first. Pick a fixed day, write it on the calendar, and set a repeating phone alarm. It also changes the cold chain. Insulin needs careful storage, and a medicine used weekly sits in the fridge far longer than one used daily. If your insulin is delivered, check how it is kept in transit, and check your own fridge temperature. If you think this medicine might suit you, the right next step is your diabetes team, not a switch you arrange yourself.

Practical advice

**Do not change your insulin on your own.** Insulin doses are worked out for you personally. Switching type or timing without your diabetes team is genuinely dangerous. **Ask at your next diabetes review whether weekly insulin is an option for you.** Bring it up yourself. It is a reasonable question, and the answer may be no for good clinical reasons. **Know the signs of low blood sugar.** Hypoglycaemia is the most common side effect of any insulin. Shaking, sweating, confusion, sudden hunger and feeling faint all count. Keep fast-acting sugar within reach. **If you move to a weekly injection, build a system.** Same day each week, written on a calendar, with a repeating alarm. Tell someone at home which day it is, so there is a second pair of eyes. **Store insulin properly.** Follow the leaflet. Check your fridge is in the right range, and never use insulin that has been frozen. **Report any suspected side effect through the Yellow Card scheme** at yellowcard.mhra.gov.uk. New medicines are watched closely, and patient reports are part of how that works. **Keep up your other diabetes care.** A simpler injection schedule does not replace eye checks, foot checks, blood pressure monitoring or HbA1c tests.

What to know

The MHRA has authorised Onswik, insulin efsitora alfa, a once-weekly basal insulin for adults with type 2 diabetes. For some people it could mean 52 injections a year instead of up to 365. NICE had already recommended it for certain adults in final draft guidance in August, conditional on this licence. The benefit on offer is convenience. The MHRA's own wording is that blood sugar control was "comparable" to once-daily insulin, not better, and the release gives no trial figures. Hypoglycaemia remains the most common side effect, as with any insulin. Who gets it will depend on NICE's criteria and local NHS prescribing decisions, so it will not reach everyone straight away. If daily injections are the thing standing between you and better diabetes control, this is worth raising at your next review. Ask the question; do not change anything yourself. Sources: Medicines and Healthcare products Regulatory Agency, "MHRA authorises Onswik (insulin efsitora alfa) for adults with type 2 diabetes", 13 October 2026, https://www.gov.uk/government/news/mhra-authorises-onswik-insulin-efsitora-alfa-for-adults-with-type-2-diabetes; Nursing in Practice, "NICE recommends weekly insulin jab for type 2 diabetes in final draft guidance", 20 August 2026, https://www.nursinginpractice.com/clinical/diabetes-and-endocrinology/nice-recommends-weekly-insulin-jab-for-type-2-diabetes-in-final-draft-guidance/; Medicines and Healthcare products Regulatory Agency, Yellow Card scheme, https://yellowcard.mhra.gov.uk This article is for general information and does not replace advice from a doctor, pharmacist, diabetes nurse or other qualified healthcare professional. Never start, stop or change insulin or any other prescribed medicine without speaking to your diabetes team first.

#type 2 diabetes#insulin#MHRA#medicines approval#NICE#medication adherence

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