Concentrated insulins: the new basal insulins

Figures & data

Table 1 Available concentrated insulins with basal coverage

Insulin	Regular	Degludec	Glargine
Brand name	Humulin-R^®	Tresiba^®	Toujeo^®
Manufacturer	Eli Lily	Novo Nordisk	Sanofi
Concentration (units/mL)	500	200	300
Vial or pen delivery	Vial	Pen	Pen
Total insulin dose capacity of delivery method	10,000 units/20 mL vial	600 units/3 mL pen	450 units/1.5 mL pen
Maximum single dose delivery (units/dose)	100	160	80
Estimated cost, wholesale (USD)a	~$1,300/20 mL vial	~$500/three pensb	~$300–$400/three pens

Notes:

a Each one is available with manufacturer coupon and rebate; approximate wholesale price may vary by location. Estimated cost assessed as of December, 2015;

b pricing is under revision in Europe. Data from Drugs.com^64,66 and GoodRx.⁶⁵

Abbreviation: USD, US dollar.

Table 2 Select PK/PD and clinical profiles of Humulin-R U500, degludec U200, and glargine U300

PK/PD parameter	Humulin-R U500^Citation9^–^Citation11,Citation33	Degludec U200^Citation14,Citation17,Citation35,Citation38,Citation39,Citation53,Citation68	Glargine U300^Citation22,Citation25,Citation42,Citation49,Citation67
Duration of action	6–10 hours	42 hours	>30 hours
Half-life	4 hours	25 hours	18–19 hours
Steady state	–	2–3 days	5 days
HbA1c reduction from baseline	−1.6% (T2DM)	−0.4% (T1DM)a −1.3% (T2DM)a	−0.4% (T1DM)a −0.8% (T2DM)a
Weight gain	+4.9 kg	+0.2 kg (T1DM)b −0.11 kg (T2DM)b	−0.6 kg (T1DM)c +0.2 kg (T2DM)b

Notes:

a Noninferior to glargine U100;

b nonsignificant mean difference between comparator and glargine U100;

c significant mean difference between comparator and glargine U100.

Abbreviations: PD, pharmacodynamic; PK, pharmacokinetic; T1DM, type 1 diabetes; T2DM, type 2 diabetes.

Figure 1 Pros and cons of concentrated basal insulin therapy.

Abbreviations: CSII, continuous subcutaneous insulin infusion; OADs, oral antidiabetic drugs.

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