NICE Assessment Outcomes | 2026

Eli Lilly’s Once-Weekly Insulin Efsitora Alfa Gains NICE Support for Type 2 Diabetes

NICE has recommended insulin efsitora alfa, developed by Eli Lilly under the brand name Onswik.

NICE said clinical evidence indicates that insulin efsitora alfa provides blood glucose control comparable to two established long-acting insulins, insulin degludec and insulin glargine.

The weekly medicine could therefore offer patients a less frequent dosing schedule without compromising the level of glucose control achieved with commonly used daily insulin treatments. It may be prescribed on its own or alongside other medicines for type 2 diabetes.

The proposed change would reduce annual injections by about 86%, from 365 daily doses to 52 weekly doses.

Potential Benefits for Patients Needing Assistance

A weekly injection could be particularly useful for people who depend on carers, family members, or healthcare professionals to administer insulin.

Potentially affected groups include:

• Older or frailer adults.

• People living with sight loss.

• Individuals with restricted hand movement.

• People with learning disabilities.

Those who struggle to maintain a daily treatment schedule.

Fewer injections could reduce the number of visits required for assistance and make insulin treatment easier to fit around work, family responsibilities, and everyday activities. NICE also highlighted possible advantages for people diagnosed with type 2 diabetes at a younger age who may be managing complex treatment while working.

NICE Leaves Treatment Choice Open

The draft guidance does not require clinicians to prescribe the weekly treatment to every eligible patient. Instead, healthcare professionals and patients are expected to discuss the advantages and disadvantages of the available options.

The final choice should be based on the patient’s needs and should take account of dosage, administration expenses, and medicine price. NICE recommends selecting the least expensive option that is appropriate for the individual.

NHS Access Still Depends on Approval

The recommendation is conditional on insulin efsitora alfa receiving a licence from the Medicines and Healthcare products Regulatory Agency.

Until MHRA approval is granted, the treatment cannot be routinely made available through the NHS in England. An appeal period is currently open, and NICE guidance is expected to be finalised if the process proceeds without a successful challenge.

Once final guidance is published, NHS England would generally be expected to fund the treatment within the applicable implementation period. Wales has separate instructions concerning NHS funding, while healthcare funding decisions in Scotland and Northern Ireland follow their own processes.

Diabetes Burden in the UK

The recommendation comes as millions of people in the UK live with diagnosed diabetes. During 2023 to 2024, approximately 4.6 million people were recorded as having diagnosed diabetes, with type 2 diabetes accounting for about nine out of ten cases.

Type 2 diabetes develops when the body does not produce enough insulin or when its cells respond poorly to the insulin available. Because insulin helps move glucose from the blood into cells for energy, impaired insulin activity can cause blood glucose levels to rise.