A large proportion of people living with type 2 diabetes treated with basal insulin therapy remain inadequately controlled despite progressive treatment intensification [1].

This lack of glycemic control leaves many patients susceptible to both microvascular and macrovascular complications. The persistence of these risks suggests that simply increasing insulin doses may not be sufficient for a significant portion of the patient population.

Insulin is a hormone medication used to regulate blood sugar and has long been one of the most important therapies for managing type 2 diabetes, according to Everyday Health [2]. However, the challenge of achieving target glucose levels persists even as clinicians escalate treatment.

Recent regulatory developments have sought to address the burden of insulin administration. In 2026, the FDA approved insulin icodec, marketed as Awiqli, as the first once-weekly, long-acting basal insulin for glycemic control in adults with type 2 diabetes [3]. This marks a shift toward reducing the frequency of injections for those requiring basal therapy.

Despite the approval for type 2 diabetes, the product faced setbacks in other areas. The medication was rejected for use in type 1 diabetes in 2024 [3].

Medical literature indicates a growing tension in diabetes management strategies. While some reports suggest that GLP-1 agonists, such as semaglutide, are reducing the overall need for insulin in many patients [2], authors in The Lancet said that a large proportion of those already on basal insulin still fail to reach adequate control [1].

This gap in care underscores the urgent need for therapies that can further improve glycemic control for people who remain inadequately managed on current basal insulin regimens [1].

“A large proportion of people living with type 2 diabetes treated with basal insulin therapy remain inadequately controlled.”

The findings suggest that the current clinical approach of escalating basal insulin doses is reaching a point of diminishing returns for many patients. While the introduction of once-weekly insulin improves adherence and quality of life, it does not necessarily solve the underlying problem of inadequate glycemic control. This creates a clinical imperative to develop more effective combination therapies, or next-generation insulin analogs, to prevent long-term organ damage.