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Insulin degludec

April 08, 2024

Insulin degludec (INN/USAN) is an ultralong-acting basal insulin analogue that was developed by Novo Nordisk under the brand name Tresiba.[6] It is administered via subcutaneous injection to help control the blood sugar level of those with diabetes. It has a duration of action that lasts up to 42 hours (compared to 18 to 26 hours provided by other marketed long-acting insulins such as insulin glargine and insulin detemir), making it a once-daily basal insulin,[7][8][9] that is one that provides a base insulin level, as opposed to the fast- and short-acting bolus insulins.

Insulin degludec
An insulin degludec hexamer. A chains are chartreuse, B chains are tan, and the central zinc atom is teal. From PDB: 4AKJ​.
Clinical data
Trade namesTresiba
AHFS/Drugs.comMonograph
MedlinePlusa615055
License data
Pregnancy
category
  • AU: B3
Routes of
administration		Subcutaneous
ATC code
Legal status
Legal status
Identifiers
  • B29N(ε)-ω-carboxypentadecanoyl-γ-L-glutamyl desB30 human insulin
CAS Number
  • 844439-96-9 N
PubChem SID
  • 124490467
ChemSpider
  • none
UNII
  • 54Q18076QB
KEGG
  • D09727 N
Chemical and physical data
FormulaC274H411N65O81S6
Molar mass6104.04 g·mol−1
 NY (what is this?)  (verify)

Insulin degludec is a modified insulin that has one single amino acid deleted in comparison to human insulin, and is conjugated to hexadecanedioic acid via gamma-L-glutamyl spacer at the amino acid lysine at position B29.

It is included on the World Health Organization's List of Essential Medicines[10] as an equivalent to insulin glargine. In 2021, it was the 146th most commonly prescribed medication in the United States, with more than 4 million prescriptions.[11][12]

Medical uses edit

Insulin degludec is indicated to improve glycemic control in people with diabetes.[4][5]

Side effects edit

A significant side effect of insulin therapy is hypoglycemia. A meta-analysis of clinical trials published in July 2012 found 39 to 47.9 events of hypoglycemia (defined as blood glucose <56 mg/dL) per patient year, with higher rates in the more concentrated degludec formulation. Rates of nocturnal hypoglycemia ranged from 3.7 to 5.1 events per patient year.[13] A more recent Cochrane systematic review found there was no significant differences in rates of diurnal, nocturnal hypoglycemia or any other studies outcomes when using insulin degludec as compared to insulin glargine, insulin detemir and NPH insulin for the management of type 1 diabetes in either adults or children.[14]

Pharmacology edit

Mechanism of action edit

Insulin degludec is an ultra-long acting insulin that, unlike insulin glargine, is active at a physiologic pH. The addition of hexadecanedioic acid via an amide linkage to lysine at the B29 position allows for the formation of multi-hexamers in subcutaneous tissues.[15] This allows for the formation of a subcutaneous depot that results in slow insulin release into the systemic circulation.[16]

Pharmacokinetics edit

Insulin degludec has an onset of action of 30–90 minutes (similar to insulin glargine and insulin detemir). There is no peak in activity, due to the slow release into systemic circulation. The duration of action of insulin degludec is reported as being longer than 24 hours.[15][13]

Because the half-life is longer than 24 hours, it is approved for daily dosing at any time each day - as long as more than 8 hours has elapsed since the previous dose.[17] A missed dose is advised to be taken as soon as remembered, then return to a normal schedule.[17]

Effectiveness profile edit

Studies have shown that participants taking insulin degludec needed to take significantly smaller doses of basal insulin than those taking insulin glargine U100, while achieving similar blood glucose levels. However, in a systematic review no clinically significant differences in measures of effectiveness were found when using insulin degludec as compared to insulin glargine, insulin detemir, and NPH insulin for the management of type 1 diabetes in either adults or children.[14] Insulin degludec also has the ability to be mixed with other insulins, thereby improving glycemic control. This cannot be done using other long-acting insulins.[18][19] A physician involved in the trials was quoted as saying,

This allows the creation of a novel formulation that retains the smooth control of a long-acting basal with rapid-acting mealtime control from insulin aspart. This 2-component insulin retains the ultralow risk characteristics of degludec with simultaneous mealtime coverage.[20]

History edit

Insulin degludec has been filed for registration in the United States.[21] After the completion of additional cardiac safety studies requested by the US Food and Drug Administration (FDA) in February 2013,[22] it received FDA approval in September 2015[23] and marketing began in January 2016.[24]

Clinical trial data edit

Type 1 diabetes edit

Insulin degludec was studied as an alternative to insulin glargine as part of a basal-bolus regimen in the BEGIN Basal-Bolus Type 1 trial. 629 participants with type 1 diabetes were randomized in a 3:1 ratio to either insulin degludec (n=472) or insulin glargine (n=157) in addition to mealtime insulin aspart. Participants in the degludec treatment arm were switched from their basal insulin to insulin degludec in a 1:1 ratio, with a 20-30% dose reduction in participants receiving multiple basal doses per day. After 52 weeks, participants treated with insulin degludec produced a similar reduction in HbA1c (0.40% vs. 0.39%) meeting the criteria for noninferiority. Adverse events were similar in the two treatment arms; however, rates of nocturnal hypoglycemia (between midnight and 6am) were 27% lower in participants treated with insulin degludec (3.91 vs. 5.22%,p=0.024). The reduction in the incidence of hypoglycemia was seen as a therapeutic benefit, as hypoglycemia is often a dose limiting toxicity in insulin therapy.[25]

A systematic review has compared the use of insulin degludec to that of insulin glargine, insulin detemir and NPH insulin in adults and children diagnosed with type 1 diabetes.[14] This review included Randomized Control Trials (RCTs) with a duration of 24 to 104 weeks and had a total sample of 8784 participants randomized across studies: 2428 participants allocated to NPH insulin; 2889 participants to insulin detemir; 2095 participants to insulin glargine; 1372 participants to insulin degludec. 21% of all participants were children. No studies directly compared insulin degludec with NPH insulin. In the studies comparing insulin degludec to insulin detemir (2 RCTs) and insulin degludec to insulin glargine (4 RCTs), no clinically relevant difference was found for the outcomes of all-cause mortality, health-related quality of life (QoL), severe hypoglycemia, non-fatal myocardial infarction/stroke (NFMI/NFS), severe nocturnal hypoglycaemia, serious adverse effects (SAE) and Glycosated haemoglobin A1c (HbA1c).[14]

Type 2 diabetes edit

In the BEGIN Basal-Bolus Type 2 trial, insulin degludec was studied as an alternative to insulin glargine in participants with type 2 diabetes. 995 participants were randomized to receive either insulin degludec (n=755) or insulin glargine (n=251), in addition to either mealtime insulin aspart, metformin, and/or pioglitazone. Participants in this trial had an average HbA1c of 8.3–8.4%, and 49–50% were on a regimen consisting of basal-bolus insulin plus oral antidiabetic medications. After 52 weeks, insulin degludec was found to be noninferior to insulin glargine, providing a similar HbA1c lowering effect (−1.10 vs. −1.18%). Overall rates of hypoglycemia were significantly lower with insulin degludec (11.09 vs. 13.63%/yr, p=0.0359), including cases of nocturnal hypoglycemia (1.39 vs. 1.84%/yr, p=0.0399).[26]

Pharmacoeconomics edit

Given the treat-to-target nature of the BEGIN trial program, much of the health economic analysis of insulin degludec has focussed on short-term cost-effectiveness based on differences in insulin dosing and hypoglycemic event incidence rather than differences in glycemic control.[27] The first cost-effectiveness analysis of this nature was conducted from a societal perspective in the Swedish setting in 2013, finding that insulin degludec would be cost-effective relative to insulin glargine in the treatment of type 1 diabetes, and type 2 diabetes as part of either a basal or basal-insulin regimen.[27]

References edit

  1. ^ "Prescription medicines: registration of new chemical entities in Australia, 2017". Therapeutic Goods Administration (TGA). 21 June 2022. from the original on 10 April 2023. Retrieved 9 April 2023.
  2. ^ https://www.tga.gov.au/resources/publication/scheduling-decisions-final/scheduling-delegates-final-decisions-january-2018/111-insulin-deglude
  3. ^ "Prescription medicines and biologicals: TGA annual summary 2017". Therapeutic Goods Administration (TGA). 21 June 2022. Retrieved 31 March 2024.
  4. ^ a b "Tresiba- insulin degludec injection, solution". DailyMed. 1 July 2022. from the original on 7 July 2022. Retrieved 11 February 2024.
  5. ^ a b "Tresiba EPAR". European Medicines Agency. 17 September 2018. from the original on 22 January 2021. Retrieved 15 January 2021.
  6. ^ Committee for Medicinal Products for Human Use (18 October 2012). (PDF). Pending EC decisions (PDF). European Medicines Agency. Archived from the original (PDF) on 11 January 2017. Retrieved 6 November 2012.
  7. ^ Klein O, Lynge J, Endahl L, Damholt B, Nosek L, Heise T (May 2007). "Albumin-bound basal insulin analogues (insulin detemir and NN344): comparable time-action profiles but less variability than insulin glargine in type 2 diabetes". Diabetes, Obesity & Metabolism. 9 (3): 290–299. doi:10.1111/j.1463-1326.2006.00685.x. PMID 17391154. S2CID 23810204.
  8. ^ Haahr H, Heise T (September 2014). "A review of the pharmacological properties of insulin degludec and their clinical relevance". Clinical Pharmacokinetics. 53 (9): 787–800. doi:10.1007/s40262-014-0165-y. PMC 4156782. PMID 25179915.
  9. ^ "Tresiba Summary of product characteristics" (PDF). European Medicines Agency. (PDF) from the original on 4 March 2016. Retrieved 29 September 2014.
  10. ^ World Health Organization (2023). The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization. hdl:10665/371090. WHO/MHP/HPS/EML/2023.02.
  11. ^ "The Top 300 of 2021". ClinCalc. from the original on 15 January 2024. Retrieved 14 January 2024.
  12. ^ "Insulin Degludec - Drug Usage Statistics". ClinCalc. Retrieved 14 January 2024.
  13. ^ a b Wang F, Surh J, Kaur M (2012). "Insulin degludec as an ultralong-acting basal insulin once a day: a systematic review". Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 5: 191–204. doi:10.2147/DMSO.S21979. PMC 3402007. PMID 22826637.
  14. ^ a b c d Hemmingsen B, Metzendorf MI, Richter B (March 2021). "(Ultra-)long-acting insulin analogues for people with type 1 diabetes mellitus". The Cochrane Database of Systematic Reviews. 3 (3): CD013498. doi:10.1002/14651858.cd013498.pub2. PMC 8094220. PMID 33662147.
  15. ^ a b Nasrallah SN, Reynolds LR (2012). "Insulin Degludec, The New Generation Basal Insulin or Just another Basal Insulin?". Clinical Medicine Insights. Endocrinology and Diabetes. 5: 31–37. doi:10.4137/CMED.S9494. PMC 3411522. PMID 22879797.
  16. ^ Robinson JD, Neumiller JJ, Campbell RK (December 2012). "Can a new ultra-long-acting insulin analogue improve patient care? Investigating the potential role of insulin degludec". Drugs. 72 (18): 2319–2325. doi:10.2165/11642240-000000000-00000. PMID 23145524. S2CID 21557012.
  17. ^ a b "Duration of Action". Novo Nordisk. from the original on 28 May 2022. Retrieved 28 April 2022.
  18. ^ "Monograph - Insulin Glargine: Dosage & Administration". American Society of Health-System Pharmacists, Inc. from the original on 28 August 2021. Retrieved 7 November 2010.
  19. ^ Ringstrom A (26 June 2010). "Novo says degludec has potential to lower blood sugar". Reuters. from the original on 12 July 2010. Retrieved 7 November 2010.
  20. ^ Lowry F. "Novel Ultralong-Acting Insulin as Effective as Insulin Glargine". Medscape. from the original on 1 April 2011. Retrieved 7 November 2010.
  21. ^ . Novo Nordisk. Archived from the original on 25 December 2014. Retrieved 27 January 2012.
  22. ^ Hirschler B (27 October 2010). "New Novo insulin fails to knock out rival Sanofi". Reuters. from the original on 2 July 2022. Retrieved 7 November 2010.
  23. ^ . U.S. Food and Drug Administration (FDA) (Press release). Archived from the original on 16 January 2016.
  24. ^ . novonordisk-us.com. Archived from the original on 22 May 2018. Retrieved 18 August 2016.
  25. ^ Heller S, Buse J, Fisher M, Garg S, Marre M, Merker L, et al. (April 2012). "Insulin degludec, an ultra-longacting basal insulin, versus insulin glargine in basal-bolus treatment with mealtime insulin aspart in type 1 diabetes (BEGIN Basal-Bolus Type 1): a phase 3, randomised, open-label, treat-to-target non-inferiority trial". Lancet. 379 (9825): 1489–1497. doi:10.1016/S0140-6736(12)60204-9. PMID 22521071. S2CID 5868807.
  26. ^ Garber AJ, King AB, Del Prato S, Sreenan S, Balci MK, Muñoz-Torres M, et al. (April 2012). "Insulin degludec, an ultra-longacting basal insulin, versus insulin glargine in basal-bolus treatment with mealtime insulin aspart in type 2 diabetes (BEGIN Basal-Bolus Type 2): a phase 3, randomised, open-label, treat-to-target non-inferiority trial". Lancet. 379 (9825): 1498–1507. doi:10.1016/S0140-6736(12)60205-0. PMID 22521072. S2CID 205965206.
  27. ^ a b Ericsson Å, Pollock RF, Hunt B, Valentine WJ (December 2013). "Evaluation of the cost-utility of insulin degludec vs insulin glargine in Sweden". Journal of Medical Economics. 16 (12): 1442–1452. doi:10.3111/13696998.2013.852099. PMID 24147661. S2CID 826947.

April 08, 2024
insulin, degludec, usan, ultralong, acting, basal, insulin, analogue, that, developed, novo, nordisk, under, brand, name, tresiba, administered, subcutaneous, injection, help, control, blood, sugar, level, those, with, diabetes, duration, action, that, lasts, . Insulin degludec INN USAN is an ultralong acting basal insulin analogue that was developed by Novo Nordisk under the brand name Tresiba 6 It is administered via subcutaneous injection to help control the blood sugar level of those with diabetes It has a duration of action that lasts up to 42 hours compared to 18 to 26 hours provided by other marketed long acting insulins such as insulin glargine and insulin detemir making it a once daily basal insulin 7 8 9 that is one that provides a base insulin level as opposed to the fast and short acting bolus insulins Insulin degludecAn insulin degludec hexamer A chains are chartreuse B chains are tan and the central zinc atom is teal From PDB 4AKJ Clinical dataTrade namesTresibaAHFS Drugs comMonographMedlinePlusa615055License dataUS DailyMed Insulin degludecPregnancycategoryAU B3Routes ofadministrationSubcutaneousATC codeA10AE06 WHO Legal statusLegal statusAU S4 Prescription only 1 2 3 US only 4 EU Rx only 5 In general Prescription only IdentifiersIUPAC name B29N e w carboxypentadecanoyl g L glutamyl desB30 human insulinCAS Number844439 96 9 NPubChem SID124490467ChemSpidernoneUNII54Q18076QBKEGGD09727 NChemical and physical dataFormulaC 274H 411N 65O 81S 6Molar mass6104 04 g mol 1 N Y what is this verify Insulin degludec is a modified insulin that has one single amino acid deleted in comparison to human insulin and is conjugated to hexadecanedioic acid via gamma L glutamyl spacer at the amino acid lysine at position B29 It is included on the World Health Organization s List of Essential Medicines 10 as an equivalent to insulin glargine In 2021 it was the 146th most commonly prescribed medication in the United States with more than 4 million prescriptions 11 12 Contents 1 Medical uses 2 Side effects 3 Pharmacology 3 1 Mechanism of action 3 2 Pharmacokinetics 4 Effectiveness profile 5 History 6 Clinical trial data 6 1 Type 1 diabetes 6 2 Type 2 diabetes 7 Pharmacoeconomics 8 ReferencesMedical uses editInsulin degludec is indicated to improve glycemic control in people with diabetes 4 5 Side effects editA significant side effect of insulin therapy is hypoglycemia A meta analysis of clinical trials published in July 2012 found 39 to 47 9 events of hypoglycemia defined as blood glucose lt 56 mg dL per patient year with higher rates in the more concentrated degludec formulation Rates of nocturnal hypoglycemia ranged from 3 7 to 5 1 events per patient year 13 A more recent Cochrane systematic review found there was no significant differences in rates of diurnal nocturnal hypoglycemia or any other studies outcomes when using insulin degludec as compared to insulin glargine insulin detemir and NPH insulin for the management of type 1 diabetes in either adults or children 14 Pharmacology editMechanism of action edit Insulin degludec is an ultra long acting insulin that unlike insulin glargine is active at a physiologic pH The addition of hexadecanedioic acid via an amide linkage to lysine at the B29 position allows for the formation of multi hexamers in subcutaneous tissues 15 This allows for the formation of a subcutaneous depot that results in slow insulin release into the systemic circulation 16 Pharmacokinetics edit Insulin degludec has an onset of action of 30 90 minutes similar to insulin glargine and insulin detemir There is no peak in activity due to the slow release into systemic circulation The duration of action of insulin degludec is reported as being longer than 24 hours 15 13 Because the half life is longer than 24 hours it is approved for daily dosing at any time each day as long as more than 8 hours has elapsed since the previous dose 17 A missed dose is advised to be taken as soon as remembered then return to a normal schedule 17 Effectiveness profile editStudies have shown that participants taking insulin degludec needed to take significantly smaller doses of basal insulin than those taking insulin glargine U100 while achieving similar blood glucose levels However in a systematic review no clinically significant differences in measures of effectiveness were found when using insulin degludec as compared to insulin glargine insulin detemir and NPH insulin for the management of type 1 diabetes in either adults or children 14 Insulin degludec also has the ability to be mixed with other insulins thereby improving glycemic control This cannot be done using other long acting insulins 18 19 A physician involved in the trials was quoted as saying This allows the creation of a novel formulation that retains the smooth control of a long acting basal with rapid acting mealtime control from insulin aspart This 2 component insulin retains the ultralow risk characteristics of degludec with simultaneous mealtime coverage 20 History editInsulin degludec has been filed for registration in the United States 21 After the completion of additional cardiac safety studies requested by the US Food and Drug Administration FDA in February 2013 22 it received FDA approval in September 2015 23 and marketing began in January 2016 24 Clinical trial data editType 1 diabetes edit Insulin degludec was studied as an alternative to insulin glargine as part of a basal bolus regimen in the BEGIN Basal Bolus Type 1 trial 629 participants with type 1 diabetes were randomized in a 3 1 ratio to either insulin degludec n 472 or insulin glargine n 157 in addition to mealtime insulin aspart Participants in the degludec treatment arm were switched from their basal insulin to insulin degludec in a 1 1 ratio with a 20 30 dose reduction in participants receiving multiple basal doses per day After 52 weeks participants treated with insulin degludec produced a similar reduction in HbA1c 0 40 vs 0 39 meeting the criteria for noninferiority Adverse events were similar in the two treatment arms however rates of nocturnal hypoglycemia between midnight and 6am were 27 lower in participants treated with insulin degludec 3 91 vs 5 22 p 0 024 The reduction in the incidence of hypoglycemia was seen as a therapeutic benefit as hypoglycemia is often a dose limiting toxicity in insulin therapy 25 A systematic review has compared the use of insulin degludec to that of insulin glargine insulin detemir and NPH insulin in adults and children diagnosed with type 1 diabetes 14 This review included Randomized Control Trials RCTs with a duration of 24 to 104 weeks and had a total sample of 8784 participants randomized across studies 2428 participants allocated to NPH insulin 2889 participants to insulin detemir 2095 participants to insulin glargine 1372 participants to insulin degludec 21 of all participants were children No studies directly compared insulin degludec with NPH insulin In the studies comparing insulin degludec to insulin detemir 2 RCTs and insulin degludec to insulin glargine 4 RCTs no clinically relevant difference was found for the outcomes of all cause mortality health related quality of life QoL severe hypoglycemia non fatal myocardial infarction stroke NFMI NFS severe nocturnal hypoglycaemia serious adverse effects SAE and Glycosated haemoglobin A1c HbA1c 14 Type 2 diabetes edit In the BEGIN Basal Bolus Type 2 trial insulin degludec was studied as an alternative to insulin glargine in participants with type 2 diabetes 995 participants were randomized to receive either insulin degludec n 755 or insulin glargine n 251 in addition to either mealtime insulin aspart metformin and or pioglitazone Participants in this trial had an average HbA1c of 8 3 8 4 and 49 50 were on a regimen consisting of basal bolus insulin plus oral antidiabetic medications After 52 weeks insulin degludec was found to be noninferior to insulin glargine providing a similar HbA1c lowering effect 1 10 vs 1 18 Overall rates of hypoglycemia were significantly lower with insulin degludec 11 09 vs 13 63 yr p 0 0359 including cases of nocturnal hypoglycemia 1 39 vs 1 84 yr p 0 0399 26 Pharmacoeconomics editGiven the treat to target nature of the BEGIN trial program much of the health economic analysis of insulin degludec has focussed on short term cost effectiveness based on differences in insulin dosing and hypoglycemic event incidence rather than differences in glycemic control 27 The first cost effectiveness analysis of this nature was conducted from a societal perspective in the Swedish setting in 2013 finding that insulin degludec would be cost effective relative to insulin glargine in the treatment of type 1 diabetes and type 2 diabetes as part of either a basal or basal insulin regimen 27 References edit Prescription medicines registration of new chemical entities in Australia 2017 Therapeutic Goods Administration TGA 21 June 2022 Archived from the original on 10 April 2023 Retrieved 9 April 2023 https www tga gov au resources publication scheduling decisions final scheduling delegates final decisions january 2018 111 insulin deglude Prescription medicines and biologicals TGA annual summary 2017 Therapeutic Goods Administration TGA 21 June 2022 Retrieved 31 March 2024 a b Tresiba insulin degludec injection solution DailyMed 1 July 2022 Archived from the original on 7 July 2022 Retrieved 11 February 2024 a b Tresiba EPAR European Medicines Agency 17 September 2018 Archived from the original on 22 January 2021 Retrieved 15 January 2021 Committee for Medicinal Products for Human Use 18 October 2012 Summary of opinion 1 initial authorisation Tresiba PDF Pending EC decisions PDF European Medicines Agency Archived from the original PDF on 11 January 2017 Retrieved 6 November 2012 Klein O Lynge J Endahl L Damholt B Nosek L Heise T May 2007 Albumin bound basal insulin analogues insulin detemir and NN344 comparable time action profiles but less variability than insulin glargine in type 2 diabetes Diabetes Obesity amp Metabolism 9 3 290 299 doi 10 1111 j 1463 1326 2006 00685 x PMID 17391154 S2CID 23810204 Haahr H Heise T September 2014 A review of the pharmacological properties of insulin degludec and their clinical relevance Clinical Pharmacokinetics 53 9 787 800 doi 10 1007 s40262 014 0165 y PMC 4156782 PMID 25179915 Tresiba Summary of product characteristics PDF European Medicines Agency Archived PDF from the original on 4 March 2016 Retrieved 29 September 2014 World Health Organization 2023 The selection and use of essential medicines 2023 web annex A World Health Organization model list of essential medicines 23rd list 2023 Geneva World Health Organization hdl 10665 371090 WHO MHP HPS EML 2023 02 The Top 300 of 2021 ClinCalc Archived from the original on 15 January 2024 Retrieved 14 January 2024 Insulin Degludec Drug Usage Statistics ClinCalc Retrieved 14 January 2024 a b Wang F Surh J Kaur M 2012 Insulin degludec as an ultralong acting basal insulin once a day a systematic review Diabetes Metabolic Syndrome and Obesity Targets and Therapy 5 191 204 doi 10 2147 DMSO S21979 PMC 3402007 PMID 22826637 a b c d Hemmingsen B Metzendorf MI Richter B March 2021 Ultra long acting insulin analogues for people with type 1 diabetes mellitus The Cochrane Database of Systematic Reviews 3 3 CD013498 doi 10 1002 14651858 cd013498 pub2 PMC 8094220 PMID 33662147 a b Nasrallah SN Reynolds LR 2012 Insulin Degludec The New Generation Basal Insulin or Just another Basal Insulin Clinical Medicine Insights Endocrinology and Diabetes 5 31 37 doi 10 4137 CMED S9494 PMC 3411522 PMID 22879797 Robinson JD Neumiller JJ Campbell RK December 2012 Can a new ultra long acting insulin analogue improve patient care Investigating the potential role of insulin degludec Drugs 72 18 2319 2325 doi 10 2165 11642240 000000000 00000 PMID 23145524 S2CID 21557012 a b Duration of Action Novo Nordisk Archived from the original on 28 May 2022 Retrieved 28 April 2022 Monograph Insulin Glargine Dosage amp Administration American Society of Health System Pharmacists Inc Archived from the original on 28 August 2021 Retrieved 7 November 2010 Ringstrom A 26 June 2010 Novo says degludec has potential to lower blood sugar Reuters Archived from the original on 12 July 2010 Retrieved 7 November 2010 Lowry F Novel Ultralong Acting Insulin as Effective as Insulin Glargine Medscape Archived from the original on 1 April 2011 Retrieved 7 November 2010 R amp D Pipeline Novo Nordisk Archived from the original on 25 December 2014 Retrieved 27 January 2012 Hirschler B 27 October 2010 New Novo insulin fails to knock out rival Sanofi Reuters Archived from the original on 2 July 2022 Retrieved 7 November 2010 FDA approves two new drug treatments for diabetes mellitus U S Food and Drug Administration FDA Press release Archived from the original on 16 January 2016 Novo Nordisk Launches Tresiba insulin degludec injection 200 Units mL in the United States novonordisk us com Archived from the original on 22 May 2018 Retrieved 18 August 2016 Heller S Buse J Fisher M Garg S Marre M Merker L et al April 2012 Insulin degludec an ultra longacting basal insulin versus insulin glargine in basal bolus treatment with mealtime insulin aspart in type 1 diabetes BEGIN Basal Bolus Type 1 a phase 3 randomised open label treat to target non inferiority trial Lancet 379 9825 1489 1497 doi 10 1016 S0140 6736 12 60204 9 PMID 22521071 S2CID 5868807 Garber AJ King AB Del Prato S Sreenan S Balci MK Munoz Torres M et al April 2012 Insulin degludec an ultra longacting basal insulin versus insulin glargine in basal bolus treatment with mealtime insulin aspart in type 2 diabetes BEGIN Basal Bolus Type 2 a phase 3 randomised open label treat to target non inferiority trial Lancet 379 9825 1498 1507 doi 10 1016 S0140 6736 12 60205 0 PMID 22521072 S2CID 205965206 a b Ericsson A Pollock RF Hunt B Valentine WJ December 2013 Evaluation of the cost utility of insulin degludec vs insulin glargine in Sweden Journal of Medical Economics 16 12 1442 1452 doi 10 3111 13696998 2013 852099 PMID 24147661 S2CID 826947 Portal nbsp Medicine Retrieved from https en wikipedia org w index php title Insulin degludec amp oldid 1216457231, wikipedia, 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