FDA Approves Second Once-Weekly Insulin for Type 2 Diabetes

Written by Ted Samson

Posted on October 20, 2026

Feel better informed on diabetes and get real support from your community.

The U.S. Food and Drug Administration (FDA) has approved Onswik (insulin efsitora alfa-gobe), a long-acting insulin taken once a week to help control blood sugar in adults with type 2 diabetes, along with diet and exercise.

Onswik is the second once-weekly insulin approved for adults with type 2 diabetes. The first, insulin icodec-abae (Awiqli), was approved in March 2026. Both are injected under the skin once a week instead of daily and help control blood sugar between meals and overnight.

However, weekly insulin doesn’t replace other parts of diabetes care. People taking insulin still need blood sugar monitoring, and some may also need other diabetes medicines, mealtime insulin, and regular medical follow-up.

🗳️ Have you ever tried an alternative to daily insulin injections?

Yes, and I currently use one

Yes, but it wasn’t right for me

No, but I’m interested

No, and I’m not interested

What Is Onswik?

Onswik is a long-acting insulin, also called a basal insulin. Basal insulin helps control blood sugar between meals and overnight. Insulin helps move glucose into cells and reduces the amount of sugar made by the liver.

Onswik is designed to control blood sugar throughout the week. It’s given as a subcutaneous (under-the-skin) injection once a week. Onswik isn’t recommended for people with type 1 diabetes because of the risk of severe hypoglycemia (dangerously low blood sugar).

Other basal insulins include intermediate-acting and longer-acting options. Depending on the type, these insulins may require one or two injections a day, while newer options can be taken once a week.

What Did Clinical Trials Show?

The FDA based its decision on four studies in adults with type 2 diabetes. The studies included:

People who’d never used insulin
People who’d previously used once-daily or twice-daily basal insulin
People who used both basal and mealtime insulin

Onswik was compared with two once-daily basal insulins: insulin glargine and insulin degludec.

Researchers measured changes in hemoglobin A1c (A1c), a blood test that shows average blood sugar levels over about three months. Across all four trials, Onswik lowered A1c by a similar amount as the daily basal insulins.

What Are the Possible Side Effects?

Like all insulin treatments, Onswik can cause side effects. The most common include:

Hypoglycemia (low blood sugar)
Allergic reactions
Injection-site reactions
Lipodystrophy (changes in fat tissue at the injection site)
Itching
Rash
Swelling
Weight gain

Severe low blood sugar can be dangerous and may cause seizures or loss of consciousness. The prescribing information also warns about serious allergic reactions, low potassium levels, and an increased risk of fluid retention and heart failure when Onswik is combined with certain diabetes medicines.

Taking Onswik too often or using the wrong dose can cause dangerously low blood sugar. The prescribing information warns about medication mix-ups and dosing mistakes. Always check the medication label and prescribed dose before each injection.

Why Does This Approval Matter for People With Type 2 Diabetes?

For adults who need basal insulin, Onswik offers another treatment option. Studies show that once-weekly Onswik can lower blood sugar as effectively as daily basal insulin, while reducing the number of basal insulin injections needed.

If you take daily insulin injections, consider talking with your healthcare provider about other available treatment options. You might ask:

Could once-weekly insulin be an option for me?
How do these treatments compare in effectiveness and side effects?
Would switching affect my blood sugar monitoring, other medications, or insurance coverage?

Your healthcare team can help you weigh the options based on your treatment needs and goals.

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