Insulin degludec is a modified human insulin with an ultra-long duration of action (more than 42 hours). The TGA recently approved a combination insulin containing insulin degludec plus insulin aspart for patients with type 1 or type 2 diabetes who require basal and prandial insulin, and it was PBS listed on 1 August 2018. What do GPs need to know about this insulin and its use in patients with diabetes?
Shortly after this article went to print, insulin degludec/insulin apart 70/30 became available on the PBS. The online version and the full text PDF of this article (see link above) have been updated.
Individuals with long-term type 2 diabetes have progressive pancreatic beta-cell failure, and many will require insulin. Conventionally, insulin may be introduced as a once-daily basal insulin, prandial insulin analogues, premixed insulin (containing a fixed proportion of soluble rapid-acting insulin analogue and intermediate-acting insoluble protamine-bound insulin) or basal-bolus multiple daily injections. Both the initiation and intensification of glucose-lowering therapy, in particular insulin, is often delayed in patients with type 2 diabetes (described as clinical inertia).1 A number of barriers to injectable therapy have been identified, including inconvenience, needle burden and weight gain. However, above all the fear of hypoglycaemia associated with more intensive insulin therapy has an impact on both clinicians and patients and may limit the reduction in glycated haemoglobin (HbA1c) achieved.2,3