title: Insulin degludec and insulin aspart: novel insulins for the management of diabetes mellitus.
abstract: Patients with type 2 diabetes mellitus require insulin as disease progresses to attain or maintain glycaemic targets. Basal insulin is commonly prescribed initially, alone or with one or more rapid-acting prandial insulin doses, to limit mealtime glucose excursions (a basal-bolus regimen). Both patients and physicians must balance the advantages of improved glycaemic control with the risk of hypoglycaemia and increasing regimen complexity. The rapid-acting insulin analogues (insulin aspart, insulin lispro and insulin glulisine) all have similar pharmacokinetic and pharmacodynamic characteristics and clinical efficacy/safety profiles. However, there are important differences in the pharmacokinetic and pharmacodynamic profiles of basal insulins (insulin glargine, insulin detemir and insulin degludec). Insulin degludec is an ultra-long-acting insulin analogue with a flat and stable glucose-lowering profile, a duration of action exceeding 30 h and less inter-patient variation in glucose-lowering effect than insulin glargine. In particular, the chemical properties of insulin degludec have allowed the development of a soluble co-formulation with prandial insulin aspart (insulin degludec/insulin aspart) that provides basal insulin coverage for at least 24 h with additional mealtime insulin for one or two meals depending on dose frequency. Pharmacokinetic and pharmacodynamic studies have shown that the distinct, long basal glucose-lowering action of insulin degludec and the prandial glucose-lowering effect of insulin aspart are maintained in the co-formulation. Evidence from pivotal phase III clinical trials indicates that insulin degludec/insulin aspart translate into sustained glycaemic control with less hypoglycaemia and the potential for a simpler insulin regimen with fewer daily injections.
authors.affiliation: Weill Cornell Medical College Qatar, Education City, PO Box 24144, Doha, Qatar.
authors.forename: Stephen
authors.initials: S
authors.lastname: Atkin
authors.affiliation: The Michael White Centre for Diabetes and Endocrinology, Hull Royal Infirmary, Hull, UK.
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Javed
authors.affiliation: Department of Endocrinology, University of Sydney, Royal North Shore Hospital, Sydney, Australia.
authors.forename: Gregory
authors.initials: G
authors.lastname: Fulcher
keywords: basal–bolus regimen; hypoglycaemia; insulin aspart; insulin degludec; insulin degludec/insulin aspart; type 2 diabetes mellitus