Exclusive: Novo Nordisk Launches World's First Once-Weekly Insulin In India

One injection a week instead of one every day. Danish drugmaker Novo Nordisk has launched Awiqli, or insulin icodec, in India-the world's first once-weekly basal insulin-cutting the annual injection count for diabetes patients from 365 to just 52.

"When we are launching this Awiqli, you called it a disruption. I call it a solution for Type 2 diabetes," Vikrant Shrotriya, Managing Director of Novo Nordisk India, told NDTV in an exclusive conversation.

Approved for adults with both Type 1 and Type 2 diabetes and delivered through a pen device called FlexTouch, the launch makes India the sixth market globally to get the therapy. It's aimed squarely at the single biggest reason patients delay insulin: the fear of daily injections. The injections will be manufactured in Denmark and the Danish drugmaker will import it to India.

Pricing Strategy: Betting On Volumes

Affordability is central to Novo Nordisk's India strategy. Shrotriya told NDTV the company has drawn on its experience pricing semaglutide in India and has applied similar lessons to Awiqli.

The 1 ml Awiqli FlexTouch pen, containing 700 units of insulin, is priced at Rs 2,611, while the larger 3 ml pen, with 2,100 units, will cost Rs 7,833. At an indicative weekly dose of 70 units, that works out to roughly Rs 261-263 a week for a patient.

"We have been able to get the pricing for the lUsersaunch in India much more affordable than even the current analogs," Shrotriya said, adding that the combination of fewer injections, competitive pricing and Novo Nordisk's distribution reach, built in partnership with Abbott, could turn Awiqli into a high-volume product.

"I really wish and hope for a volume play," he said. "With this kind of pricing, with the kind of distribution network which we have got, the volume play comes into the picture."

Looking Beyond Insulin: The GLP-1 Opportunity

Shrotriya also used the conversation to look past the insulin segment, pointing to what he sees as a much longer runway for GLP-1 drugs in India.

He described the recent burst of competitive activity in the category as "mass hysteria," but argued the country is only at the start of a much longer growth curve, noting that less than 0.5 percent of India's obese population currently uses these medicines, compared with roughly 15-20% in the United States.

Even with semaglutide's patent exclusivity having lapsed, Shrotriya said the company remains confident in its position. "Quality, trust and reliability continues," he said, pointing to Novo Nordisk's pipeline of upcoming therapies, including an oral Wegovy pill, CagriSema, zenagamtide and a once-weekly growth hormone treatment. "Innovation is not going to stop. This journey of science and innovation continues in Novo Nordisk," he said.

What The Science Shows

Novo Nordisk's Awiqli is not a like-for-like swap with existing insulins, it is far more concentrated, which changes how it behaves in the body. Endocrinologist Dr S.K. Wangnoo of Indraprastha Apollo Hospital, New Delhi, explained the science to NDTV in an exclusive interaction.

Dr Wangnoo said the shift from up to seven injections a week to just one addresses three concerns simultaneously, convenience, effectiveness and safety.

On convenience, he noted there is no longer a need for a daily jab. On effectiveness, he said the once-weekly formulation works as well as established daily basal insulins such as glargine. And on safety, he pointed out that switching patients from daily injections to the weekly version has resulted in markedly fewer episodes of hypoglycaemia, or dangerously low blood sugar, long the single biggest fear patients associate with starting insulin.

He explained that this safety edge comes down to pharmacology: Awiqli is a highly concentrated insulin, at 700 units per ml, so a patient who might take around 10 units a day would receive roughly 70 units in a single weekly dose.

As the volume injected is small and the insulin is absorbed slowly and steadily over seven days, blood sugar levels are controlled evenly through the week without the sharp peaks that can trigger hypoglycaemia.

Dosing itself does not change in principle, he said, it is simply consolidated into a once-a-week shot, and doctors can now review and adjust the dose weekly or fortnightly instead of every third day, as was often the case with daily insulin.

Dr Wangnoo added that Awiqli has been cleared for both Type 1 and Type 2 diabetes patients above 18 years, following the ONWARDS clinical trial programme, which tested it against multiple daily injections, oral medication and other insulin regimens across diverse patient groups.

Data from the ONWARDS-1 study showed Awiqli delivered superior reduction in HbA1c, a key marker of average blood sugar, and better "time in range" compared with once-daily insulin glargine U100, while keeping a comparable safety profile. More Type 2 patients on Awiqli also achieved HbA1c levels below 7 percent without experiencing hypoglycaemia, the company said.

"This has found to be more superior, effective and safe, and that is why it is going to be very good news for all our diabetic patients who can switch from the daily injection to one shot a week," Dr Wangnoo said.

A Massive, Under-Treated Population

India's diabetes burden is among the largest in the world. The country has over 10.1 crore people living with diabetes and another 13.6 crore with prediabetes, along with more than 9 lakh people living with Type 1 diabetes, an autoimmune condition where insulin therapy is central to management. Roughly 10 percent of Type 2 diabetics, a metabolic condition where the body cannot use insulin effectively, also eventually need insulin.

Despite this scale, insulin adoption remains strikingly low. Shrotriya told NDTV that only about six to seven million people in India currently take insulin, even though an estimated 25-30 percent of diabetes patients may need it at some stage. "One of the issues by which the majority of patients actually don't take insulin is because of the fear of multiple injections, daily injections," he said, adding that with Awiqli, "once a week, a patient can be initiated with a basal insulin."

Shrotriya told NDTV that this fear of daily jabs, combined with the effort of frequent blood-sugar monitoring, contributes to insulin initiation in India being delayed by an average of seven to nine years.

Recent National Family Health Survey (NFHS-6) data has also flagged a sharp rise in high blood-sugar prevalence across both urban and rural India, adding urgency to the need for simpler treatment options. A 2022 nationwide study backed by the Indian Council of Medical Research (ICMR) and coordinated by the Madras Diabetes Research Foundation had found that only one in three people with known diabetes had their condition under control, underlining just how wide the treatment gap remains.

Shrotriya called the launch "a defining moment" for diabetes care in India, saying the once-weekly regimen could ease both the psychological and physical barriers that keep patients from starting insulin therapy on time.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.