Novo Nordisk is launching its first-of-its-kind weekly insulin dose for type 2 diabetes, offering greater convenience and less pain, but the downside of the injection is hypoglycaemia risks, reports The Washington Post.
More than 36m people in the United States have type 2 diabetes, and roughly 22% of them – or about 8m – require daily insulin injections to control their blood glucose levels.
Since last week, that gruelling regimen can now be reduced to just one shot a week, after Novo’s announcement that it is rolling out a weekly insulin injection called Awiqli.
It is the first-of-its-kind weekly dose to reach the market, after approval by the Food and Drug Administration (FDA) in March.
The appeal of reducing 365 shots a year to 52 is obvious: greater convenience, less pain. Novo Nordisk says removing the daily requirement can create “a routine that feels more manageable.”
But there are other issues to keep in mind, most importantly, the risk of hypoglycaemia, or low blood sugar, which Novo Nordisk said was a common adverse reaction in Awiqli clinical trials.
Another factor is access: it is not yet clear which insurance plans in the US will cover Awiqli and whether they will require patients to jump through hoops to qualify for coverage.
Two doctors who specialise in treating diabetes discuss what patients need to keep in mind.
Is this drug for everyone who requires insulin for type 2 diabetes? Who could benefit most?
Some of the most obvious candidates for a once-weekly jab are people with disabilities, elderly people in assisted-living facilities, people with memory problems, or others who have trouble keeping track of their blood sugar and insulin needs on their own, said Rozalina McCoy, an endocrinologist at the University of Maryland School of Medicine.
“It would be very helpful for those people to have somebody come to the home once a week to give them an injection. That is a huge advantage,” said McCoy, who was not involved in the drug’s development.
For people in nursing homes where low staffing is a constant issue, she added, reducing insulin to a weekly dose would ease the burden on nurses.
Yet extra caution is required to guard against hypoglycaemia in the elderly, which may cause doctors to hesitate before prescribing Awiqli, said Kasia Lipska, a Yale School of Medicine endocrinologist.
“I think this will be a niche type of insulin and not widely adopted,” she said. “Its main advantage – the long duration of action – is also its central limitation.”
Novo Nordisk said that Awiqli, as the only weekly insulin available, offers patients an option, and “recognises the importance of personalised care and the need for treatments that fit different routines and preferences for adults living with type 2 diabetes”.
What are the potential problems? What are considerations for glucose monitoring throughout the week?
Patients should still monitor their glucose every day, McCoy said, so doctors will know the size of the weekly dose that is required. And they should start with a conservative dose, so their blood sugar is not pushed down too low with a drug that will be in their system all week.
If a patient is already doing well on a daily insulin dose, doctors can multiply it by seven to calculate the Awiqli dose, McCoy added, citing the FDA-approved label.
Pricing of the injection
The list price of Awiqli will be $99 for a box containing a single, multi-dose injector pen. How long the pen lasts depends on the dose each patient requires; some patients could use less than a whole pen in a month, others more. Novo Nordisk defines a monthly supply as two pens.
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