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Degludec

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https://www.readbyqxmd.com/read/28721686/rationale-for-initiation-and-titration-of-the-basal-insulin-glp-1ra-fixed-ratio-combination-products-ideglira-and-iglarlixi-for-the-management-of-type-2-diabetes
#1
REVIEW
Virginia Valentine, Jennifer Goldman, Jay H Shubrook
Type 2 diabetes (T2D) is a progressive disease affecting glucose regulation and a major cause of morbidity and mortality globally. Many patients are not escalated up the treatment ladder appropriately despite failing to achieve glycemic control, with barriers such as fear of hypoglycemia, weight gain, and treatment burden recognized as factors. Exogenous basal insulin is titrated to address control of fasting plasma glucose and may preserve residual β-cell function, thus promoting a greater endogenous prandial insulin response...
July 18, 2017: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/28704062/flextouch-an-insulin-pen-injector-with-a-low-activation-force-across-different-insulin-formulations-needle-technologies-and-temperature-conditions
#2
Niels Gudiksen, Thibaud Hofstätter, Birgitte B Rønn, Thomas Sparre
FlexTouch® (Novo Nordisk A/S, Bagsvaerd, Denmark) is a pen-injector with a torque spring mechanism requiring a low activation force. This laboratory-based study compared the activation force of FlexTouch during the injection of insulin with different needles and at temperature conditions within the range at which the device is recommended for use. Using a tensile tester, activation force was measured at maximum dose settings for insulin detemir (100 U/mL) and insulin degludec (100 and 200 U/mL) at standard (23°C ± 5°C), cool (5°C ± 3°C), and warm (30°C ± 2°C) conditions...
July 13, 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28683068/prediction-of-nocturnal-hypoglycemia-unawareness-by-fasting-glucose-levels-or-post-breakfast-glucose-fluctuations-in-patients-with-type-1-diabetes-receiving-insulin-degludec-a-pilot-study
#3
Hiroshi Takahashi, Rimei Nishimura, Yoshiko Onda, Kiyotaka Ando, Daisuke Tsujino, Kazunori Utsunomiya
OBJECTIVE: To evaluate whether nocturnal asymptomatic hypoglycemia (NAH) can be predicted by fasting glucose levels or post-breakfast glucose fluctuations in patients with type 1 diabetes (T1D) receiving insulin degludec. METHODS: Patients with T1D receiving insulin degludec underwent at-home CGM assessments. Indices for glycemic variability before and after breakfast included fasting glucose levels and the range of post-breakfast glucose elevation. For comparison, the patients were classified into those with NAH and those without...
2017: PloS One
https://www.readbyqxmd.com/read/28672317/effect-of-insulin-degludec-vs-insulin-glargine-u100-on-hypoglycemia-in-patients-with-type-2-diabetes-the-switch-2-randomized-clinical-trial
#4
RANDOMIZED CONTROLLED TRIAL
Carol Wysham, Anuj Bhargava, Louis Chaykin, Raymond de la Rosa, Yehuda Handelsman, Lone N Troelsen, Kajsa Kvist, Paul Norwood
Importance: Hypoglycemia, a serious risk for insulin-treated patients with type 2 diabetes, negatively affects glycemic control. Objective: To test whether treatment with basal insulin degludec is associated with a lower rate of hypoglycemia compared with insulin glargine U100 in patients with type 2 diabetes. Design, Setting, and Participants: Randomized, double-blind, treat-to-target crossover trial including two 32-week treatment periods, each with a 16-week titration period and a 16-week maintenance period...
July 4, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28672316/effect-of-insulin-degludec-vs-insulin-glargine-u100-on-hypoglycemia-in-patients-with-type-1-diabetes-the-switch-1-randomized-clinical-trial
#5
RANDOMIZED CONTROLLED TRIAL
Wendy Lane, Timothy S Bailey, Gregg Gerety, Janusz Gumprecht, Athena Philis-Tsimikas, Charlotte Thim Hansen, Thor S S Nielsen, Mark Warren
Importance: Hypoglycemia, common in patients with type 1 diabetes, is a major barrier to achieving good glycemic control. Severe hypoglycemia can lead to coma or death. Objective: To determine whether insulin degludec is noninferior or superior to insulin glargine U100 in reducing the rate of symptomatic hypoglycemic episodes. Design, Setting, and Participants: Double-blind, randomized, crossover noninferiority trial involving 501 adults with at least 1 hypoglycemia risk factor treated at 84 US and 6 Polish centers (January 2014-January 12, 2016) for two 32-week treatment periods, each with a 16-week titration and a 16-week maintenance period...
July 4, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28651211/effect-of-insulin-degludec-versus-insulin-glargine-on-glycemic-control-and-daily-fasting-blood-glucose-variability-in-insulin-na%C3%A3-ve-japanese-patients-with-type-2-diabetes-i-d-got-trial
#6
Yoshimasa Aso, Kunihiro Suzuki, Yasuko Chiba, Minoru Sato, Nobuya Fujita, Yoshihisa Takada, Shunichi Murano, Hisamoto Kuroda
AIMS: Insulin degludec (IDeg) is an ultra-long-acting insulin that has a smooth time/action profile over more than 42h. The present study compared the effects of IDeg and insulin glargine (IGlar) on HbA1c reduction and on within-subject day-to-day variability of fasting blood glucose (FBG) in insulin-naïve patients with type 2 diabetes. SUBJECTS AND METHODS: Eligible patients were randomly allocated at a 3:1 ratio to receive once-daily IDeg (n=31) or IGlar (n=12)...
June 15, 2017: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/28649881/cost-effectiveness-analysis-of-insulin-degludec-compared-with-insulin-glargine-u100-for-the-management-of-type-1-and-type-2-diabetes-mellitus-from-the-spanish-national-health-system-perspective
#7
Pedro Mezquita-Raya, Josep Darbà, Meritxell Ascanio, Antonio Ramírez de Arellano
BACKGROUND: The objective of this study was to assess the cost-effectiveness of insulin degludec versus insulin glargine, from the Spanish NHS in three groups of patients. METHODS: A short-term cost utility model was developed to estimate effectiveness results in terms of the total number of hypoglycaemic events and their disutility impact throughout the year on the initial level of quality of life for patients in each treatment. RESULTS: Degludec was the dominant strategy for T2DM BOT and exhibited an incremental cost-effectiveness ratio of 52...
June 26, 2017: Expert Review of Pharmacoeconomics & Outcomes Research
https://www.readbyqxmd.com/read/28643425/ideglira-was-effective-across-a-range-of-dysglycaemia-and-bmi-categories-in-the-dual-v-randomized-trial
#8
Ildiko Lingvay, Stewart Harris, Elmar Jaeckel, Keval Chandarana, Mattis F Ranthe, Esteban Jódar
This study assessed the efficacy of insulin degludec/liraglutide (IDegLira) versus insulin glargine U100 (IGlar) across categories of baseline HbA1c (≤7.5%, >7.5- ≤ 8.5% and >8.5%), body mass index (BMI; <30, ≥30- < 35 and ≥35 kg/m(2) ) and fasting plasma glucose (FPG; <7.2 and ≥7.2 mmol/L) in patients with type 2 diabetes (T2D) uncontrolled on basal insulin, using post hoc analyses of the DUAL V 26-week trial. With IDegLira, mean HbA1c was reduced across all baseline HbA1c (1...
June 23, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28643293/-why-is-a-combination-of-basal-insulin-with-a-glp-1-receptor-agonist-useful-in-many-patients-with-type-2-diabetes
#9
Michael Nauck, Birgit Wilhelm
BACKGROUND: In 2015, the combination of basal insulin and GLP-1 receptor agonist (RA) was incorporated into the guideline recommendations for type 2 diabetes as an option for the last escalation step. The two antidiabetics to be injected subcutaneously are complementary regarding their respective main effects and limitations. Basal insulin is predominantly active between meals and in the fasting state, whereas the main action of GLP-1 RA consists in preventing an excessive postprandial blood glucose increase...
June 2017: MMW Fortschritte der Medizin
https://www.readbyqxmd.com/read/28624930/basal-and-bolus-insulin-dose-changes-after-switching-basal-insulin-to-insulin-degludec-in-patients-with-type-1-diabetes%C3%A2-mellitus-a-pilot-study
#10
Yoshiyuki Hamamoto, Sachiko Honjo, Kanta Fujimoto, Shinsuke Tokumoto, Hiroki Ikeda, Yoshiharu Wada, Hiroyuki Koshiyama
BACKGROUND AND OBJECTIVES: Ultra-long-acting insulin degludec (DEG) has a longer duration of action and less daily variability relative to other basal insulin (BI), and thus may benefit patients with type 1 diabetes mellitus (T1DM). We examined the impact of switching BI to DEG on glycemic control and insulin dose in T1DM. METHODS: T1DM patients (n = 22; six male; mean age: 64.5 ± 12.6 years) receiving basal-bolus insulin therapy were included. Initially, the BI dose was replaced with DEG in a 1:1 ratio; 80-100% of the total dose was replaced with DEG for multiple basal insulin injections...
June 17, 2017: Clinical Drug Investigation
https://www.readbyqxmd.com/read/28605603/efficacy-and-safety-of-degludec-versus-glargine-in-type-2-diabetes
#11
Steven P Marso, Darren K McGuire, Bernard Zinman, Neil R Poulter, Scott S Emerson, Thomas R Pieber, Richard E Pratley, Poul-Martin Haahr, Martin Lange, Kirstine Brown-Frandsen, Alan Moses, Simon Skibsted, Kajsa Kvist, John B Buse
Background Degludec is an ultralong-acting, once-daily basal insulin that is approved for use in adults, adolescents, and children with diabetes. Previous open-label studies have shown lower day-to-day variability in the glucose-lowering effect and lower rates of hypoglycemia among patients who received degludec than among those who received basal insulin glargine. However, data are lacking on the cardiovascular safety of degludec. Methods We randomly assigned 7637 patients with type 2 diabetes to receive either insulin degludec (3818 patients) or insulin glargine U100 (3819 patients) once daily between dinner and bedtime in a double-blind, treat-to-target, event-driven cardiovascular outcomes trial...
June 12, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28585180/efficacy-and-safety-of-insulin-degludec-for-hyperglycemia-management-in-noncritical-hospitalized-patients-with-diabetes-an-observational-study
#12
Natalino Simioni, Alessio Filippi, Marco Scardapane, Antonio Nicolucci, Maria Chiara Rossi, Vera Frison
INTRODUCTION: To assess the efficacy and safety of insulin degludec administered in a basal-bolus regimen according to the GesTIO protocol in noncritical hospitalized patients with T1DM and T2DM. METHODS: Mean blood glucose levels (BG) and their standard deviations (SD) at admission vs. discharge were compared in 52 subjects (48.1% ≥75 years) managed through a basal-bolus scheme including degludec. The percentages of patients with BG at target (140-180 mg/dl) or below at discharge and the incidence rate (and the 95% confidence interval for it) of hypoglycemia were assessed...
June 5, 2017: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/28547206/glycemic-variability-in-type-1-diabetes-compared-with-degludec-and-glargine-on-the-morning-injection-an-open-label-randomized-controlled-trial
#13
Ryo Iga, Hiroshi Uchino, Ken Kanazawa, Shuki Usui, Masahiko Miyagi, Naoki Kumashiro, Hiroshi Yoshino, Yasuyo Ando, Takahisa Hirose
INTRODUCTION: Optimal adjustment of basal insulin to overcome hypoglycemia and glycemic variability (GV) depends on its duration of action and peak-less profile. Owing to the ability of long-acting basal insulin to avoid hypoglycemia, we titrated pre-meal glucose to normal fasting blood glucose, 80-110 mg/dL (4.5-6.1 mmol/L), and post-meal glucose to 80-140 mg/dL (4.5-7.8 mmol/L). The purpose of this study was to evaluate two basal insulin analogues degludec (IDeg) and glargine (IGlar), injected in the morning, for GV using continuous glucose monitoring (CGM) in type 1 diabetes (T1DM)...
May 25, 2017: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/28537449/understanding-how-pharmacokinetic-and-pharmacodynamic-differences-of-basal-analog-insulins-influence-clinical-practice
#14
Jennifer Goldman, Christoph Kapitza, Jeremy Pettus, Tim Heise
This article reviews pharmacokinetic (PK) and pharmacodynamic (PD) concepts relating to the pharmacology of basal insulin analogs. Understanding the pharmacology of currently available long-acting basal insulins and the techniques used to assess PK and PD parameters (e.g. the euglycemic clamp method) is important when considering the efficacy and safety of these agents, and can help in understanding the rationale for specific dosing strategies when tailoring therapy for a specific patient. Basal insulins such as insulin glargine 100 units (U)/mL and insulin detemir show improved PK/PD characteristics compared with the intermediate-acting NPH insulin, with a longer duration of action, a more consistent glucose-lowering effect and less prominent concentration peaks...
June 23, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28523483/modeling-the-long-term-cost-effectiveness-of-ideglira-in-patients-with-type-2-diabetes-who-are-failing-to-meet-glycemic-targets-on-basal-insulin-alone-in-the-netherlands
#15
Barnaby Hunt, Divina Glah, Maarten van der Vliet
INTRODUCTION: Insulin degludec/liraglutide (IDegLira) is the first basal insulin and glucagon-like peptide-1 receptor agonist (GLP-1 RA) in a single pen injection device, and a once-daily treatment option for patients with type 2 diabetes mellitus (T2DM) who are uncontrolled on basal insulin and require treatment intensification. The objective of this analysis was to evaluate the long-term cost-effectiveness of IDegLira versus basal-bolus therapy (insulin glargine U100 + 3× daily insulin aspart) for patients with T2DM uncontrolled on basal insulin [HbA1c >53 mmol/mol (>7%)] in the Netherlands...
May 18, 2017: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/28511140/different-impacts-of-acylated-and-non-acylated-long-acting-insulin-analogs-on-neural-functions-in-vitro-and-in-vivo
#16
Hiroshi Tsuneki, Hitomi Yoshida, Kosuke Endo, Norihiko Mori, Shuji Hosoh, Masaaki Tsuda, Tsutomu Wada, Toshiyasu Sasaoka
AIMS: Centrally administered insulin improves cognitive functions in patients with Alzheimer's disease; however, it remains unknown whether long-acting insulin analogs exert more pronounced effects than insulin. In the present study, we directly compared the effects of insulin and its analogs on neural functions in vitro and in vivo. METHODS: Cultured rat cerebral cortical neurons were treated with insulin, insulin glargine U100 (Gla), insulin detemir (Det), or insulin degludec (Deg)...
July 2017: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/28505544/real-life-experience-of-patients-starting-insulin-degludec-a-multicenter-analysis-of-1064-subjects-from-the-german-austrian-dpv-registry
#17
Barbara Bohn, Artur Zimmermann, Christian Wagner, Sigrun Merger, Desirée Dunstheimer, Florian Kopp, Katja Gollisch, Volker Zindel, Reinhard W Holl
BACKGROUND: The long-acting insulin analogue degludec is a therapeutic option for patients with type 1 (T1D) or type 2 diabetes (T2D). Aim of this analysis was to investigate differences in clinical characteristics of patients before and after initiating degludec use in a cohort of German/Austrian patients. METHODS: 1064 subjects with T1D/T2D and documented degludec use from the Diabetes-Patient-Follow-Up (DPV) registry were included. The follow-up cohort (n=421) comprised patients with available data before and 3-15months after switching to degludec...
July 2017: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/28475455/higher-concentration-insulins-an-overview-of-clinical-considerations
#18
REVIEW
Timothy S Reid, Fryn Schafer, Cynthia Brusko
Three higher concentration insulin products (insulin lispro 200 units/mL, insulin degludec 200 units/mL, and insulin glargine 300 units/mL) received US Food and Drug Administration (FDA) approval in 2015. Although human regular insulin 500 units/mL (U-500) was approved in 1997, a pen and dedicated U-500 syringe became available in 2016. These products offer more treatment options for the increasing numbers of patients requiring insulin to achieve and maintain glycemic targets. Higher concentration insulins have some unique safety and efficacy considerations...
June 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28458515/united-states-experience-of-insulin-degludec-alone-or-in-combination-for-type-1-and-type-2-diabetes
#19
REVIEW
Marc Rendell
Insulin degludec has been the product of a sophisticated and systematic biochemical engineering program which began with the release of insulin detemir. The goal was to produce a long-lasting basal insulin with low individual variability. Certainly, this goal has been achieved. Degludec has a duration of action approaching twice that of glargine. Another advantage of degludec is in its lack of unpredictable copolymerization of added aspart. In several studies, degludec has shown lower rates of nocturnal hypoglycemia than glargine...
2017: Drug Design, Development and Therapy
https://www.readbyqxmd.com/read/28442823/insulin-degludec-200-units-ml-is-associated-with-lower-injection-frequency-and-improved-patient-reported-outcomes-compared-with-insulin-glargine-100-units-ml-in-patients-with-type-2-diabetes-requiring-high-dose-insulin
#20
Mark L Warren, Louis B Chaykin, Serge Jabbour, Mae Sheikh-Ali, Charlotte T Hansen, Thor S S Nielsen, Paul Norwood
IN BRIEF Many patients with type 2 diabetes require high basal insulin doses, necessitating multiple injections, increasing patient burden, and resulting in reduced treatment adherence. This randomized, controlled, crossover trial compared the efficacy, safety, and patient-reported outcomes for a concentrated formulation of insulin degludec (200 units/mL) to those of insulin glargine in patients requiring high doses of basal insulin. By offering equivalent glycemic control while reducing the rate of confirmed hypoglycemia and the number of injections required for administration, insulin degludec 200 units/mL may be preferred by patients with type 2 diabetes who require high basal insulin doses...
April 2017: Clinical Diabetes: a Publication of the American Diabetes Association
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