Insulin degludec (Tresiba) is a long-acting insulin analogue given once daily as a subcutaneous injection for basal insulin therapy. It has a duration of action beyond 42 hours within the therapeutic dose range. On occasions when administration at the same time of the day is not possible, insulin degludec allows for flexibility in the timing of insulin administration. A minimum of 8 hours between injections should always be ensured (Insulin degludec: (Tresiba) summaries of product characteristics).
The licensed indication is treatment of diabetes mellitus in adults (Insulin degludec (Tresiba): summaries of product characteristics). This evidence summary covers only the use of once-daily insulin degludec, as a single preparation, in adults with type 2 diabetes. (A combination preparation containing both insulin degludec and insulin aspart has also been licensed but has not yet been marketed within the UK).
Insulin degludec is a basal insulin for once-daily subcutaneous administration at any time of the day, preferably at the same time every day. In people with type 2 diabetes mellitus, it can be administered alone, in combination with oral antidiabetic drugs as well as in combination with bolus insulin. It is dosed in accordance with the individual patient's needs. On occasions when administration at the same time of the day is not possible, insulin degludec allows for flexibility in the timing of insulin administration. A minimum of 8 hours between injections should always be ensured (Insulin degludec (Tresiba): summaries of product characteristics).
Insulin degludec is available in 2 strengths: 100 units/ml and 200 units/ml. The dose-counter window of the pen device shows the number of units that will be injected, irrespective of strength. Therefore, no dose conversion is needed when transferring a person from one strength of insulin degludec to another. This is the first insulin approved in Europe at a higher strength than the European Union-wide standard of 100 units/ml. The Medicines and Healthcare Products Regulatory Agency (MHRA) has issued advice to minimise the risk of medication errors associated with a 200 units/ml formulation (see the section on safety for more information; Drug Safety Update April 2013).
Insulin degludec (Tresiba) is available in packs of 5×3 ml cartridges of 300 units/cartridge (100 units/ml) compatible with the NovoPen at a cost of £72.00. It is also available in the FlexTouch pre-filled pen device as a 5×3 ml – 300 units/pen (100 units/ml) at a cost of £72.00 and a double-strength 3×3 ml – 600 units/pen (200 units/ml) at a cost of £86.40. Costs are excluding VAT; taken from MIMS (July 2013).