Understanding the Clinical Profile of Insulin Degludec, the Latest Basal Insulin Approved for Use in Canada: a Narrative
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REVIEW
Understanding the Clinical Profile of Insulin Degludec, the Latest Basal Insulin Approved for Use in Canada: a Narrative Review Vincent Woo . Lori Berard . Robert Roscoe
Received: May 11, 2020 The Author(s) 2020
ABSTRACT In recent years, the development of basal insulin therapies has focused on insulin analogues that have longer durations of action and more predictable pharmacokinetic/pharmacodynamic (PK/PD) profiles than their human insulin-based predecessors, such as neutral protamine Hagedorn (NPH) insulin. Dosed once-daily, such analogues can provide a more stable glucose-lowering action, which translates clinically into a reduced risk of hypoglycemia. Insulin degludec (degludec) became available in Canada in 2017 and is the first basal insulin analogue to have a half-life exceeding the dosing interval. As well as offering the promise of an exceptionally flat PK/PD profile when at steady state, this characteristic means that insulin degludec can be dosed with some flexibility with regard to time of day and that it need not be taken at the same time each day. However, the approximately 25-h half-life also has some implications concerning dose titration. This article provides an up-to-date review of the study data describing the Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12820778. V. Woo (&) L. Berard University of Manitoba, Winnipeg, MB, Canada e-mail: [email protected] R. Roscoe Diabetes Education Centre, Saint John Regional Hospital, Saint John, NB, Canada
clinical profile of degludec, and aims to give helpful and practical advice to prescribers about its use. While the clinical benefits of degludec are described, it is also acknowledged that further study is required to better understand how its clinical performance compares with that of insulin glargine 300 units/mL.
Keywords: Basal insulin; Insulin Type 1 diabetes; Type 2 diabetes
degludec;
Key Summary Points Insulin degludec (degludec) is an innovative basal insulin with some unique pharmacological properties that translate into clinical benefits. Degludec carries a relatively low risk of hypoglycemia and can be dosed flexibly (at different times each day) to benefit patient convenience. The very long half-life of degludec means there are some important considerations that prescribers need to be mindful of regarding dose titration. Further studies are required to fully differentiate the clinical profiles of degludec and insulin glargine 300 units/ mL.
Diabetes Ther
DIGITAL FEATURES This article is published with digital features to facilitate understanding of the article. You can access the digital features on the article’s associated Figshare page. To view digital features for this article go to https://doi.org/10.6084/m9. figshare.12820778.
INTRODUCTION Insulin degludec (degludec) was launched in Canada in late 2017 and is the first major new basal insulin product for 2 years (since the introduction of insulin glargine 300 units/mL [glargine U300]), and the first new b
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