Insulin Degludec, The New Generation Basal Insulin or Just another Basal Insulin?

Abstract

The advances in recombinant DNA technology have led to an improvement in the properties of currently available long-acting insulin analogs. Insulin degludec, a new generation ultra-long-acting basal insulin, currently in phase 3 clinical trials, has a promising future in clinical use. When compared to its rival basal insulin analogs, a longer duration of action and lower incidence of hypoglycemic events in both type 1 and type 2 diabetic patients has been demonstrated.1,2 Its unique mechanism of action is based on multihexamer formation after subcutaneous injection. This reportedly allows for less pharmacodynamic variability and within-subject variability than currently available insulin analogs, and a duration of action that is over 24 hours.3 The lack of proof of carcinogenicity with insulin degludec is yet another factor that would be taken into consideration when choosing the optimal basal insulin for a diabetic individual.4 A formulation of insulin degludec with insulin aspart, Insulin degludec 70%/aspart 30%, may permit improved flexibly of dosing without compromising glycemic control or safety.5

New Long-Acting Basal Insulins: Does Benefit Outweigh Cost?

“…However, the risk of hypoglycemia, especially nocturnal hypoglycemia, was further reduced by ;25% during the maintenance period of the trials despite somewhat lower fasting plasma glucose concentrations (40). In addition, insulin degludec allows a more flexible approach to the timing of insulin administration to better accommodate the recipients' ever-changing daily life pattern (1,3,4,10,13,50,54). Such improved convenience seems to result in better compliance with therapy and an enhancement in the patients' quality of life (50,54).…”

“…In summary of these and findings from other comparative studies, the following practical, evidence-based notions become apparent (1,3,4,(9)(10)(11)(12)(13)(14)(16)(17)(18) to a reduced rate of overall hypoglycemia and less weight gain compared with therapies based on regular human insulin and NPH insulin. c In contrast to insulin detemir, insulin glargine typically lowers blood glucose for 24 h, thus allowing for a once-a-day basal insulin regimen in most patients.…”

“…In comparison, the duration of action of NPH insulin is considerably shorter, being up to 16 h and dose dependent, with a clear peak action after 4-6 h (1,3,4,(9)(10)(11)(12)(13)(14). The latter property may be responsible for nocturnal hypoglycemia sometime between 2:00 and 4:00 A.M., after the administration of NPH insulin at bedtime, or late morning hypoglycemia, when NPH insulin is given before breakfast and its peak action not sufficiently covered by an appropriate snack.…”

“…The latter property may be responsible for nocturnal hypoglycemia sometime between 2:00 and 4:00 A.M., after the administration of NPH insulin at bedtime, or late morning hypoglycemia, when NPH insulin is given before breakfast and its peak action not sufficiently covered by an appropriate snack. The long-acting insulin detemir has a flatter peak action profile than NPH at low doses, but at higher doses a peak action is evident 7-14 h after administration (1,3,4,(9)(10)(11)(12)(13)15). The long-acting insulin glargine has an even smoother peak action profile than insulin detemir but has a discernable peak action 3-4 h after administration while possessing a duration of action of 24 h or more, depending on the dose (1,3,4,(9)(10)(11)(12)(13)15).…”

A Novel Selective and Sensitive Electrochemical Sensor for Insulin Detection

“…Salimi et al's electrode had a better LOD than Jaafariasl et al's electrode but worse sensitivity. In the present work, we fabricate a silica gel/chitosan/Ni(OH) 2 paste electrode to measure insulin in 0.1 M phosphate buffer (pH 7.4) that demonstrates better performance in terms of sensitivity and LOD than both Salimi et al's and Jaafariasl et al's electrodes.…”