So you are asking yourself—which is the better long acting insulin?
Lantus® or Tresiba® ?
The judges have declared the winner, and it wasn’t even close! First, some back story in order to understand the importance of this epic fight. Why would Tresiba want to take on Lantus? Lantus has been the champion of long-acting insulin for over fifteen years. That’s right! Lantus was an amazing discovery for diabetes management: the first long-acting basal insulin. Before the year 2000, doctors did not have many types of insulin to choose from.
Lantus is actually an analogue of natural human insulin. The insulin molecule was changed slightly in the lab, creating differences in the way it is absorbed. In the case of U-100 glargine (the generic name of Lantus), there is an amino acid substitution and a slight lengthening of one of the two chains that make up the insulin molecule. When Lantus is injected, this alteration increases the time over which the insulin is absorbed, giving it a longer half-life than all the insulins available previously.
Fast-forward sixteen years, and Tresiba is now an excellent alternative for what doctors call basal insulin. Basal insulin is a type of insulin that lasts long periods of time and helps control blood sugars between meals and overnight. Several changes were made to slow the absorption of Tresiba, making its effect on lower blood sugar more predictable. As compared to regular insulin, Tresiba contains an amino acid deletion and a special bond with a fatty acid. When combined with zinc and phenol, degludec (the generic name of Tresiba) forms multihexamers under the skin. Once absorbed, it reversibly binds to the main protein in the blood, called albumin. The end result of these modifications is a new class of insulin referred to as “ultra-long-acting basal insulin”.
Summary of the major differences between the two basal insulins: Glargine vs Degludec
What is the better long acting insulin?
Just recently, in June 2017, the results from the DEVOTE study were released. Not only did it reveal that Tresiba is safe on the heart, but as compared to Lantus, Tresiba caused 40% less very low blood sugars and 53% less severe hypoglycemia overnight. This study might have landed a knockout punch to the basal-insulin giant, but it wasn’t the first punch Tresiba threw against Lantus.
In fact, studies have demonstrated that Tresiba works just as well in controlling the A1c as the long-acting Lantus, and when patients are switched from Lantus to Tresiba, they experience up to 51% lower rates of severe hypoglycemia.
If we are to crown Tresiba the new champion of all long-acting insulin, it is a champion with a not-so-secret downside. Tresiba can do some damage to your pocket book, as it weighs in at nearly twice the price of Lantus.
The glargine molecule that is in the Lantus SoloStar pen is now also produced by Lilly under the branded name BasaGlar. It should be noted that even though glargine has been around for almost twenty years, it is not quite at generic prices, as insulin analogues require highly skilled production facilities.
Disclosures: The author, Dr.Christopher Palmeiro, has no financial relationships to disclose.
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