No evidence of benefit for insulin analogs over nph insulin

No evidence of benefit for insulin analogs over nph insulin

Tujeo and Tresiba are two new long-acting insulin analogs that can be prescribed to patients with type 1 and type 2 diabetes to maintain normal blood glucose levels between meals and at night.

Patients with type 1 diabetes should combine this type of insulin with the insulin recommended for administration at meals – most often with a similar short action. Patients with type 2 diabetes can take prolonged insulin along with oral medications that reduce blood sugar.
Role of basal insulin

Why do you need insulin between meals and at night, when the body is not supplied with carbohydrates?

It’s not just food that affects your blood sugar levels. At night and in long intervals between meals, the liver releases glucose into the blood, which is necessary for the brain to work. Hormones that counteract insulin-growth hormone, cortisol, epinephrine, glucagon-work around the clock, effectively increasing glycemia. That’s why we need insulin no matter what we eat.

This is how a healthy pancreas works – it releases insulin in very small amounts throughout the day. And when the blood sugar level starts to rise with food, it releases a large amount of insulin.

The goal of insulin therapy in people with diabetes is to recreate this regimen. That is, you need to inject insulin and maintain normoglycemia during the fasting period and when eating. For this purpose, intermediate-acting human insulins or long-acting analogs are used, and fast – acting NPH insulins or short-acting analogs are used during meals.

Togeo and Tresina – a new basal insulin

Basal insulin requirements

The ideal basal insulin should, first of all, be stable, which means that during the entire period of its activity, it should reduce blood sugar levels with the same intensity, and not even lower it, but “control”it. The main advantages of long-acting insulin analogues such as Lantus and Levemir are a peak-free activity profile and a time of activity in the body-up to 24 hours.

At the time of their introduction to the market, it was a revolution compared to the previously available long-acting human insulin. Older drugs were active up to a maximum of 18 hours, and therefore had to be administered twice a day. They also had a clear peak of action, occurring 8 hours after injection, which increases the risk of hypoglycemia at night. Togeo and Tresina as Lantus, – insulins with a flat action profile.

Tujeo insulin – who can use it and why?

Insulin Togeo – not that other, as is well known to diabetics Lantus, only much more concentrated. This means that it can be entered in a smaller volume. Standard lanthus is produced in a concentration of 100 units per 1 ml, in the case of Tujeo, the concentration is 300 units per 1 ml. Thus, we can say that Togeo is a concentrated Lantus.

What does this mean for patients? First, they can inject themselves with smaller doses of basal insulin. For people with type 1 diabetes, this is not a big deal. However, among obese patients with type 2 diabetes and high insulin resistance, there are those who require more than 100 units of basal insulin per day. In this case, the volume of the administered dose is of great importance.

Smaller doses cause minor damage to the subcutaneous tissue. Moreover, it was found that the volume of the dose also affects the effect of insulin itself. Studies comparing Tujeo and Lantus insulins have shown that the more concentrated form of insulin glargine (the active ingredient in both drugs) is characterized by greater stability of action, carries a lower risk of hypoglycemia and a lower risk of weight gain. These benefits were particularly noted in obese patients who received high doses of insulin.

To sum up, Tujeo is a concentrated form of insulin glargine, available in a lower degree in Lantus or in the biosimilar insulin Abasaglar. This is an insulin that works for 22-24 hours. But it is important to keep track of the time of introduction. If a patient who normally gives basal insulin at 9 p.m. forgets to give it, for example, three hours late, they are likely to develop hyperglycemia.

Tresiba-super-long-acting analog

Tresiba is a new analog of human insulin that has an ultra-long-lasting effect. The time of its activity in the body exceeds 42 hours. The active substance in Tresiba is insulin degludec. The most important differences regarding Lantus insulin relate to its flexible administration. In this case, there is no need to adhere to the standard time of administration of basal insulin, except that it should not be used more often than every 8 hours.

Insulin degludec has a very stable and predictable action profile. This is a drug that does not work immediately, creating a kind of insulin deposits in the subcutaneous tissue. This Deposit gradually enters the bloodstream.

After starting insulin therapy with this drug, the full spectrum of its action is visible after 8 days of regular use. Only after this time, the deposition of insulin in the subcutaneous tissue is sufficiently stabilized to be able, for example, to assess whether the correct dose of the drug was chosen. This, of course, does not mean that Tresiba does not work on the first day of introduction. But in order for it to work at full capacity, it must have time to “acclimatize” in the body. This should be kept in mind when starting and completing insulin therapy with this drug. In these cases, it also takes about a week.

Studies have shown that the use of Tresiba has the same effect on the level of glycosylated hemoglobin as treatment with Lantus. But in patients using the super-long-acting analog, less severe hypoglycemia was observed in more than 50% of cases (including the night period)and about 40% less hypoglycemia.

However, studies have shown that the risk of cardiovascular events with the use of the insulin Tresiba and Lantus is comparable, although it depends on the frequency and severity of hypoglycemia episodes. Tresiba usually requires lower doses of insulin than Lantus, so when changing the drug, it is recommended to reduce the dosage by 20%.

Tresiba insulin is available in vials and as a single-use pen. It allows you to inject up to 160 units of insulin in a single bolus, which is useful for people with very high insulin resistance who have to inject very large boluses of insulin at a time.

Douglas Badenoch
I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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