Recent advances with insulin degludec for the treatment of Type 2 diabetes

Abstract

Type 2 diabetes has been referred to as the global epidemic of the 21st century, and is associated with significant morbidity and premature mortality. Estimates suggest that over 50% of people with Type 2 diabetes will at some point need insulin injections to help treat their diabetes. Once daily insulin injections are being increasingly used to initiate insulin in people with Type 2 diabetes and the development of novel, safe, once daily basal insulins with low rates of hypoglycaemia are important to help achieve internationally recommended glycaemic targets for individual patients. Insulin degludec is a novel once daily basal insulin analogue that has been developed for use in people with Type 2 diabetes. A comprehensive drug development program suggests that it can achieve comparable glycaemic control to existing basal insulins but with reduced rates of hypoglycaemia.

Keywords::

• basal analog insulin
• insulin degludec
• pharmacodynamics
• pharmacokinetics
• reduced hypoglycemia
• safety
• ultra-long duration of action

Financial & competing interests disclosure

SCL Gough has received honoraria, for lectures and attending advisory boards, from Novo Nordisk, Eli Lilly, Sanofi, GSK and Takeda. He has also received research grants from Novo Nordisk, Sanofi and Takeda. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Insulin degludec (IDeg) has a prolonged and stable pharmacokinetic profile of over 24 h in patients with Type 2 diabetes mellitus.

• It is associated with reduced frequency of hypoglycemic events, particularly nocturnal hypoglycemia, when compared with insulin glargine.

• IDeg may be suitable for use in combination with OADs, as basal insulin, in insulin-naïve patients or as part of a basal bolus regimen.

• IDeg can be combined with the rapid-acting analog (insulin aspart), and the glucagon-like peptide-1 receptor agonist liraglutide (IDegLira), while maintaining the distinct pharmacological properties of the mono-components.

• IDeg is available in a U200 formulation for those requiring large doses of insulin.

• Safety and efficacy of IDeg are preserved in the elderly, in patients with renal and liver co-morbidities and those requiring large doses of insulin.

• A further cardiovascular safety study is ongoing.

Notes