Insulin Degludec, a Long-Acting Once-Daily Basal Analogue for Type 1 and Type 2 Diabetes Mellitus

Abstract

Here, we discuss certain practical issues related to use of insulin degludec, a new long-acting basal insulin analogue. Degludec provides uniform ("peakless") action that extends over more than 24 hours and is highly consistent from dose to dose. Like the 2 previously available basal analogues (detemir and glargine), degludec is expected to simplify dose adjustment and enable patients to reach their glycemic targets with reduced risk of hypoglycemia. Phase 3 clinical trials involving type 1 and type 2 diabetes have demonstrated that degludec was noninferior to glargine in allowing patients to reach a target glycated hemoglobin (A1C) of 7%, and nocturnal hypoglycemia occurred significantly less frequently with degludec. In addition, when dosing intervals vary substantially from day to day, degludec continues to be effective and to maintain a low rate of nocturnal hypoglycemia. Degludec thus has the potential to reduce risk of nocturnal hypoglycemia, to enhance the flexibility of the dosing schedule and to improve patient and caregiver confidence in the stability of glycemic control. A dedicated injector, the FlexTouch prefilled pen, containing degludec 200 units/mL, will be recommended for most patients with type 2 diabetes. Degludec will also be available as 100 units/mL cartridges, to be used in the NovoPen 4 by patients requiring smaller basal insulin doses, including most patients with type 1 diabetes.

Understanding the Clinical Profile of Insulin Degludec, the Latest Basal Insulin Approved for Use in Canada: a Narrative Review

“…Using this simple titration algorithm (in which the dose is either kept the same or increased/decreased by 4 units according to a single pre-breakfast blood glucose value), A1C reduction was non-inferior to a more elaborate ‘step-wise’ titration algorithm, and there were no significant differences in other control and tolerability outcomes. As an alternative, a simple twice-weekly titration algorithm has also been proposed [ 61 ]. In this algorithm, 2 titration days are nominated at 3- to 4-day intervals; the degludec dose is left unchanged if the fasting glucose on the titration day is within the range of 4.0 and 7.0 mmol/L, but decreased or increased by 2 units if the value is < 4.0 or > 7.0 mmol/L, respectively; doses are then maintained until the next titration day.…”

Advances in Basal Insulin Therapy

“…For both, the dose can be selected on the dial so no volume calculations or conversions are required (as with the SoloSTAR device). 36…”

“…For both, the dose can be selected on the dial so no volume calculations or conversions are required (as with the SoloSTAR device). 36 It is important to note that Gla-300, Deg-100, and Deg-200 are all basal insulin formulations that provide basal coverage with once-daily injection. Prandial excursions in blood glucose should be covered with alternative therapy options, if needed.…”

The Clinical Impact of Switching Basal Insulin to Insulin Degludec in Patients With Diabetes in Saudi Arabia: A Retrospective One-Group Pretest-Posttest Design Study

“…Accumulating evidence from literature has ensured the safety profile of insulin degludec. Insulin degludec was proven to allow glycemic control to reach a target of glycated hemoglobin of 7% with a low frequency of nocturnal hypoglycemia, even with substantial variation in dosing intervals, thus allowing dosing schedule flexibility and stability of glycemic control [ 17 ].…”