Afrezza, a rapid-acting inhaled human insulin, is delivered through a specially designed inhaler comprised of single-use cartridges. In January , Sanofi-Aventis announced it would no longer distribute Afrezza because of poor sales, and it is unclear whether Afrezza will remain on the market in the United States. Information from Afrezza prescribing information. Accessed March 14, U regular human insulin is now available as a pen. This product is indicated for patients whose total dosage of U insulin is more than units per day.
Unlike the vial formulation, the pen does not require a dose conversion when switching from U insulin formulations. Dose adjustments must be made in 5-unit increments because of the dose increments available in the pen. U regular human insulin is the most concentrated formulation of insulin available as a pen and allows for the administration of the largest number of insulin units per injection.
It is also associated with increased patient satisfaction and reduced cost. The U glargine pen Toujeo Solostar is a long-acting analogue insulin that was developed to reduce injection volume and provide a gradual insulin release to increase its duration of action to more than 24 hours. Toujeo Solostar allows dosing with 1-unit increments with even numbers visible in the dose counter window. Although its amino acid sequence is identical to Lantus, it is not considered a biosimilar product in the United States because it did not go through the FDA's biosimilar drug approval process.
The degludec pen Tresiba Flextouch is an ultra—long-acting analogue insulin that is available in two concentrations U and U with similar safety, effectiveness, and pharmacokinetic profiles. Dose conversion is not required when switching between the two. Patients inject Tresiba Flextouch once daily at any time, but there must be at least eight hours between injections.
Tresiba Flextouch can be combined in solution with rapid-acting insulin. This combination has been shown to provide similar reduction in A1C values while significantly lowering the risk of overall confirmed, nocturnal confirmed, and severe hypoglycemia. Patients should continue their previously used short- or rapid-acting insulin at the same dose before meals not covered by this product. This article updates previous articles on this topic by Petznick , 26 and by Mayfield and White. Data Sources : We searched PubMed using the following terms: type 2 diabetes treatment, prediabetes treatment, hypoglycemic agents, nutrition and diabetes, diabetes and cardiovascular disease.
We also searched Essential Evidence Plus. Search dates: January and July Already a member or subscriber? Log in. At the time this article was written, she was a second-year resident in ambulatory care pharmacy and academia at the University of Tennessee Health Science Center College of Pharmacy. Reprints are not available from the authors. Defronzo RA. Banting Lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus.
Prospective Diabetes Study Group. Overview of 6 years' therapy of type II diabetes: a progressive disease. Achievement of goals in U. N Engl J Med. Centers for Disease Control and Prevention. Diabetes report card Accessed May 21, Management of blood glucose with noninsulin therapies in type 2 diabetes. Addition of biphasic, prandial, or basal insulin to oral therapy in type 2 diabetes. Three-year efficacy of complex insulin regimens in type 2 diabetes [published correction appears in N Engl J Med. Diabetes-related distress, insulin dose, and age contribute to insulin-associated weight gain in patients with type 2 diabetes: results of a prospective study.
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Rates of complications and mortality in older patients with diabetes mellitus: the diabetes and aging study.
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Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Severe hypoglycemia and risks of vascular events and death. Hypoglycemia: minimizing its impact in type 2 diabetes. Risk of dementia in diabetes mellitus: a systematic review [published correction appears in Lancet Neurol. Lancet Neurol. Comparative effect of human soluble insulin and insulin aspart upon hypoglycaemia-induced alterations in cardiac repolarization.
Br J Clin Pharmacol. Does hypoglycaemia increase the risk of cardiovascular events? Eur Heart J. Petznick A. Red Book online. Accessed September 30, Long-acting insulin analogues versus NPH insulin human isophane insulin for type 2 diabetes mellitus. Cochrane Database Syst Rev. Short acting insulin analogues versus regular human insulin in patients with diabetes mellitus. A randomised, week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose-lowering drugs in insulin-naive people with type 2 diabetes.
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Frequency of self-monitoring blood glucose and attainment of HbA1c target values. Acta Diabetol. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risks of complications in patients with type 2 diabetes UKPDS 33 [published correction appears in Lancet. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes UKPDS 34 [published correction appears in Lancet.
Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. Glucose control and vascular complications in veterans with type 2 diabetes [published correction appears in N Engl J Med. Intensive glycaemic control for patients with type 2 diabetes: systematic review with meta-analysis and trial sequential analysis of randomised clinical trials. Clin Pharmacol Drug Dev. Humalog U website.
Afrezza website. Technosphere insulin Afrezza : a new, inhaled prandial insulin.
Glucose Monitoring Resources
Ann Pharmacother. Humulin R U website. Accessed April 10, Clinical use of U regular insulin: review and meta-analysis. J Diabetes Sci Technol. Toujeo website. Diabetes Obes Metab. Food and Drug Administration. Clin Drug Investig. The efficacy and safety of insulin degludec given in variable once-daily dosing intervals compared with insulin glargine and insulin degludec dosed at the same time daily: a week, randomized, open-label, parallel-group, treat-to-target trial in individuals with type 2 diabetes.
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.
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Insulin degludec versus insulin glargine in insulin-naive patients with type 2 diabetes: a 1-year, randomized, treat-to-target trial BEGIN Once Long. J Diabetes Investig.
Hypoglycaemia risk with insulin degludec compared with insulin glargine in type 2 and type 1 diabetes: a pre-planned meta-analysis of phase 3 trials. Comparison of insulin degludec with insulin glargine in insulin-naive subjects with type 2 diabetes: a 2-year randomized, treat-to-target trial. Tresiba website. J Diabetes.
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Insulin therapy for type 2 diabetes: rescue, augmentation, and replacement of beta-cell function [published correction appears in Am Fam Physician. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv aafp. Want to use this article elsewhere?
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