A once-weekly insulin: MHRA authorises Onswik for type 2 diabetes

On 13 October 2026 the UK medicines regulator, the MHRA, authorised Onswik — insulin efsitora alfa. It is a long-acting basal insulin given once a week. For some people with type 2 diabetes that means 52 injections a year instead of up to 365.

What exactly was authorised, and for whom

The authorisation covers the treatment of type 2 diabetes mellitus in adults. The marketing authorisation holder is Eli Lilly Nederland B.V., and the licence was granted through the ACCESS Procedure. The MHRA decision says nothing about type 1 diabetes.

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How a weekly insulin differs from a daily one

The difference is how often it is injected. Onswik is given once a week, while conventional basal insulins require an injection every day. According to the clinical trial data cited by the MHRA, blood sugar control was comparable to once-daily basal insulin treatments.

The regulator's announcement does not name the trials, give HbA1c figures or state how many people took part — only the conclusion that glycaemic control was comparable.

What side effects are named

The most common adverse reaction is hypoglycaemia, a fall in blood sugar. That is an expected property of any insulin, but with a weekly regimen it is worth agreeing in advance with your clinician what to do if an episode happens.

The MHRA said it will keep monitoring the medicine's safety through its surveillance systems. If you suspect a side effect, speak to a doctor, pharmacist or nurse, and you can also report it yourself through the Yellow Card scheme on the regulator's website or in its app. Anyone can report — you do not have to be a health professional.

Will it be available on the NHS, and when

An MHRA authorisation is market access, not automatic NHS availability. That decision belongs to NICE, which has already published final draft guidance recommending insulin efsitora alfa as an option for certain adults with type 2 diabetes. The recommendation was conditional on an MHRA licence — which now exists.

NICE's own appraisal schedule (ID6499) gives an expected publication date of 22 October 2026. The MHRA announcement gives no timing for the medicine reaching pharmacies and clinics.

What should someone with diabetes do now

Nothing on their own, and changing a regimen unilaterally would be dangerous: insulin therapy is prescribed by a clinician, and moving from a daily basal insulin to a weekly one is a decision for the diabetes team, not the patient. The sensible step is to note the question for your next scheduled review and ask whether the new regimen suits you.

The full documentation — the Summary of Product Characteristics and the Patient Information Leaflet — will be published on the MHRA Products website later. Until then, details of dosing and contraindications are not publicly available.

Do you pay for this prescription

Diabetes mellitus is on the list of conditions qualifying for a medical exemption certificate: if it is treated by anything other than diet alone, you get a certificate lasting 10 years and pay nothing for prescriptions in England. Your GP provides the application form, the certificate is posted within 10 working days and is backdated to one month before receipt. People aged 60 or over do not need to apply — their prescriptions are free anyway.

In short

The regulator has authorised the UK's first once-weekly basal insulin for adults with type 2 diabetes. Blood sugar control in trials was comparable to daily insulins, the main risk named is hypoglycaemia, and NHS availability rests with NICE, whose appraisal is due on 22 October 2026.

ONLYWAY NEWS notes that this is a report on a regulator's decision, not medical advice. Discuss any change in treatment with your clinician.