Insulin remains a necessary, effective, and safe therapeutic option today, especially in specific clinical conditions, even in type 2 diabetes. Our country is approaching a new era in the history of insulin. We are indeed close to the availability of the first weekly basal insulin formulations. The AMD annals present a unique chance to evaluate the evolution of pharmacological therapies for diabetes in recent years. The AMD annals confirm that in 2023 still more than 32% of the population with type 2 diabetes in Italy was treated with insulin, and more than 97% of subjects were treated with basal insulin. The appropriate prescription of insulin is hindered by numerous obstacles, resulting in therapeutic inertia. Among these, the non-acceptance of daily injection therapy and the difficulty in adherence justify the rationale for developing weekly basal insulin Among the weekly basal insulins in development, icodec and efsitora are the closest to being introduced into our clinical practice. The development of new biotechnological approaches has resulted in the development of insulins with a half-life of 8 and 17 days for icodec and efsitora, respectively. Icodec and efsitora, in the QWINT and ONWARDS phase 3 programs, have been shown to be effective in achieving primary and secondary efficacy endpoints. The two weekly basal insulins have shown that in the context of an oral basal regimen for people with type 2 diabetes, the risk of hypoglycemia is not different from that of daily basal insulins In studies in type 1 diabetes and in people with type 2 diabetes on basal bolus insulin therapy, the risk of hypoglycemia was found to be higher for new weekly basal insulins than for daily basal insulins, bringing up the need for more research and possibly a different prescribing approach for basal weekly insulins in this population. The reduction in the number of injections results in patients being more satisfied with the treatment, this could result in a significant improvement in quality of life and an increase in acceptance and adherence to prescribed treatment, and finally, it responds to the urgent need to counter therapeutic inertia in the care of people with diabetes.