Patient safety and minimizing risk with insulin administration - Role of insulin degludec

Myint M. Aye, Stephen Atkin

Research output: Contribution to journalReview article

18 Citations (Scopus)

Abstract

Diabetes is a lifelong condition requiring ongoing medical care and patient self-management. Exogenous insulin therapy is essential in type 1 diabetes and becomes a necessity in patients with longstanding type 2 diabetes who fail to achieve optimal control with lifestyle modification, oral agents, and glucagon-like peptide 1-based therapy. One of the risks that hinders insulin use is hypoglycemia. Optimal insulin therapy should therefore minimize the risk of hypoglycemia while improving glycemic control. Insulin degludec (IDeg) is a novel basal insulin that, following subcutaneous injection, assembles into a depot of soluble multihexamer chains. These subsequently release IDeg monomers that are absorbed at a slow and steady rate into the circulation, with the terminal half-life of IDeg being ~25 hours. Thus, it requires only once-daily dosing unlike other basal insulin preparations that often require twice-daily dosing. Despite its long half-life, once-daily IDeg does not cause accumulation of insulin in the circulation after reaching steady state. IDeg once a day will produce a steady-state profile with a lower peak:trough ratio than other basal insulins. In clinical trials, this profile translates into a lower frequency of nocturnal hypoglycemia compared with insulin glargine, as well as an ability to allow some flexibility in dose timing without compromising efficacy and safety. Indeed, a study that tested the extremes of dosing intervals of 8 and 40 hours showed no detriment in either glycemic control or hypoglycemic frequency versus insulin glargine given at the same time each day. While extreme flexibility in dose timing is not recommended, these findings are reassuring. This may be particularly beneficial to elderly patients, patients with learning difficulties, or others who have to rely on health-care professionals for their daily insulin injections. Further studies are required to confirm whether this might benefit adherence to treatment, reduce long-term hypoglycemia or reduce diabetes-related complications.

Original languageEnglish
Pages (from-to)55-67
Number of pages13
JournalDrug, Healthcare and Patient Safety
Volume6
Issue number1
DOIs
Publication statusPublished - 30 Apr 2014
Externally publishedYes

Fingerprint

Patient Safety
Insulin
Hypoglycemia
Half-Life
Insulins
Glucagon-Like Peptide 1
Aptitude
Diabetes Complications
Subcutaneous Injections
Therapeutics
Self Care
insulin degludec
Type 1 Diabetes Mellitus
Hypoglycemic Agents
Type 2 Diabetes Mellitus
Life Style
Patient Care
Clinical Trials
Learning
Delivery of Health Care

Keywords

  • Basal insulin
  • Diabetes
  • Hypoglycemia
  • Safety

ASJC Scopus subject areas

  • Pharmacology
  • Health Policy

Cite this

Patient safety and minimizing risk with insulin administration - Role of insulin degludec. / Aye, Myint M.; Atkin, Stephen.

In: Drug, Healthcare and Patient Safety, Vol. 6, No. 1, 30.04.2014, p. 55-67.

Research output: Contribution to journalReview article

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