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insulin degludec (Tresiba)

FDA approves Sept 2015. Indications: - treatment of type 2 diabetes mellitus - may be used in association with metformin - may be used for treatment of type 1 diabetes mellitus Dosage: - start 10 units SQ QD or 20 units SQ three times a week Pharmacokinetics: - 1/2 life > 25 hours - duration of action (>40 hours)* * roughly twice that of insulin glargine (Lantus) Adverse effects: - hypoglycemia - hypoglycemia occurs less often than with insulin glargine [6] - nocturnal hypoglycemia occurs less often than with insulin glargine [1,2] Mechanism: - long-acting insulin analog - forms soluble multihexamer assemblies after subcutaneous injection, resulting in an ultra-long action profile. Notes: - too expensive [5]

Interactions

drug adverse effects of hypoglycemic agents

General

insulin analog (synthetic insulins, recombinant insulins)

References

  1. Heller S et al. Insulin degludec, an ultra-longacting basal insulin, versus insulin glargine in basal-bolus treatment with mealtime insulin aspart in type 1 diabetes (BEGIN Basal-Bolus Type 1): A phase 3, randomised, open-label, treat-to-target non-inferiority trial. Lancet 2012 Apr 21; 379:1489 PMID: 22521071
  2. Garber AJ et al. Insulin degludec, an ultra-longacting basal insulin, versus insulin glargine in basal-bolus treatment with mealtime insulin aspart in type 2 diabetes (BEGIN Basal-Bolus Type 2): A phase 3, randomised, open-label, treat-to-target non-inferiority trial. Lancet 2012 Apr 21; 379:1498 PMID: 22521072
  3. Zinman B et al. Insulin degludec versus insulin glargine in insulin-naive patients with type 2 diabetes: A 1-year, randomized, treat-to-target trial (BEGIN Once Long). Diabetes Care 2012 Dec; 35:2464 PMID: 23043166
  4. FDA News Release. September 25, 2015 FDA approves two new drug treatments for diabetes mellitus http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm464321.htm
  5. California Institute for Clinical and Economic Review, 2015 Insulin Degludec (Tresiba, Novo Nordisk A/S) for the Treatment of Diabetes: Effectiveness, Value, and Value-Based Price Benchmarks. http://ctaf.org/sites/default/files/u148/Diabetes_Draft_Report_122115.pdf
  6. Lane W, Bailey TS, Gerety G et al Effect of Insulin Degludec vs Insulin Glargine U100 on Hypoglycemia in Patients With Type 1 Diabetes. The SWITCH 1 Randomized Clinical Trial. JAMA. 2017;318(1):33-44 PMID: 28672316 http://jamanetwork.com/journals/jama/article-abstract/2635629 - Wysham C, Bhargava A, Chaykin L et al Effect of Insulin Degludec vs Insulin Glargine U100 on Hypoglycemia in Patients With Type 2 Diabetes. The SWITCH 2 Randomized Clinical Trial. JAMA. 2017;318(1):45-56. PMID: 28672317 http://jamanetwork.com/journals/jama/article-abstract/2635630 - Seaquist ER, Chow LS Hypoglycemia in Diabetes. Does Insulin Type Matter? JAMA. 2017;318(1):31-32 PMID: 28672298 http://jamanetwork.com/journals/jama/article-abstract/2635610

Component-of

degludec/liraglutide (Xultophy) insulin degludec/insulin aspart