Insulin degludec has comparable control of blood glucose to insulin glargine [2-4]. Its long duration of action raises the possibility of three times weekly treatment regimes [3] which may be useful for certain types of care home setting or the older person living at home with medical and social support.
Degludecplus is a formulation of degludec with insulin aspart (rapid acting). Both Degludec and Degludecplus have been submitted for approval in Europe, USA and Japan.
1. Kalra S, Unnikrishnan AG, Baruah M, Kalra B. Degludec insulin: A novel basal insulin. Indian J Endocrinol Metab 2011 Jul;15(Suppl 1):S12–16.[cited 2012 Apr 1] Available from: http://www.ncbi.nlm.nih.gov/pubmed/21847448
2. Heise T, Tack CJ, Cuddihy R, Davidson J, Gouet D, Liebl A, Romero E, Mersebach H, Dykiel P, Jorde R. A new-generation ultra-long-acting basal insulin with a bolus boost compared with insulin glargine in insulin-naive people with type 2 diabetes: a randomized, controlled trial. Diabetes Care 2011 Mar;34(3):669–674.[cited 2011 Jun 13] Available from: http://www.ncbi.nlm.nih.gov/pubmed/21285389
3. Zinman B, Fulcher G, Rao PV, Thomas N, Endahl LA, Johansen T, Lindh R, Lewin A, Rosenstock J, Pinget M. Insulin degludec, an ultra-long-acting basal insulin, once a day or three times a week versus insulin glargine once a day in patients with type 2 diabetes: a 16-week, randomised, open-label, phase 2 trial. The Lancet 2011 Mar;377(9769):924–931.[cited 2011 Mar 15] Available from: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62305-7/abstract
4. Birkeland KI, Home PD, Wendisch U, Ratner RE, Johansen T, Endahl LA, Lyby K, Jendle JH, Roberts AP, DeVries JH, Meneghini LF. Insulin degludec in type 1 diabetes: a randomized controlled trial of a new-generation ultra-long-acting insulin compared with insulin glargine. Diabetes Care 2011 Mar;34(3):661–665.[cited 2012 Apr 1] Available from: http://www.ncbi.nlm.nih.gov/pubmed/21270174
I participated in the Phase IIIa programme of Degludec Plus. Our protocol compared Insulin Degludec Plus with Insulin Glargine (both once daily). The expectation in the beginning was Degludec Plus may prove superior to Glargine by virtue of the availability of 30% Aspart in its composition thereby controlling the major mealtime spike. Surprisingly the HbA1c reductions were similar, but Degludec Plus arm required significantly more number of units than Glargine to achieve the same level of HbA1c.
ReplyDeleteSince Degludec has an action extending up to 36 hours, there was a proof of concept trial where they tried it on Monday, Wednesday and Friday every week in one arm versus daily shots in the other arm. Though the results in the 3 day/week arm was encouraging, this concept was not pursued in the Phase IIIa programme.
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