From the Guidelines
Tresiba (insulin degludec) has been shown to have lower rates of severe and nocturnal hypoglycemia compared to earlier basal insulins, but direct comparisons with Toujeo (insulin glargine U300) are mixed, with some studies suggesting similar safety profiles. The choice between Tresiba and Toujeo should be individualized based on patient factors, insurance coverage, and previous insulin experience. Some key points to consider when choosing between these insulins include:
- Tresiba has demonstrated lower rates of severe and nocturnal hypoglycemia compared to earlier basal insulins like Lantus (insulin glargine U100) in the SWITCH and BEGIN trials 1.
- Both Tresiba and Toujeo have flatter, more stable pharmacokinetic profiles than older basal insulins, contributing to reduced glycemic variability and potentially fewer hypoglycemic events.
- The BRIGHT trial, a head-to-head comparison of these two ultra-long-acting insulins, found that Toujeo actually had fewer hypoglycemic events during the titration period, though rates were similar during the maintenance phase 1.
- Patients should monitor blood glucose regularly when using either insulin and adjust doses gradually under medical supervision to minimize hypoglycemia risk.
- Long-acting insulin analogues, such as Tresiba and Toujeo, may be considered for patients with type 1 or type 2 diabetes who have frequent severe hypoglycemia with human insulin, according to the World Health Organization guidelines 1.
From the FDA Drug Label
The incidence of severe hypoglycemia was lower in the TRESIBA group as compared to the insulin glargine U-100 group (Table 16). Percent of patients with events 4.9% 6.6% Estimated odds ratio [95%CI] TRESIBA/Insulin glargine U-100 0.73 [0.60; 0.89]* Events per 100 Patient Years of Observation 3.70 6. 25 Estimated rate ratio [95%CI] TRESIBA/Insulin glargine U-100 0.60 [0.48; 0.76]*
TRESIBA has a lower incidence of severe hypoglycemia compared to insulin glargine U-100, with an estimated odds ratio of 0.73 [0.60; 0.89] and an estimated rate ratio of 0.60 [0.48; 0.76] 2.
- Key findings:
- 4.9% of patients in the TRESIBA group experienced severe hypoglycemia, compared to 6.6% in the insulin glargine U-100 group.
- The estimated rate of severe hypoglycemia per 100 patient-years of observation was 3.70 for TRESIBA and 6.25 for insulin glargine U-100. However, the question asks about Toujeo, not insulin glargine U-100, so no conclusion can be drawn about the comparison between TRESIBA and Toujeo.
From the Research
Hypoglycemia Rates Comparison
- The provided studies compare the hypoglycemia rates of insulin degludec (Tresiba) with insulin glargine U100, but not directly with Toujeo.
- However, it can be noted that Toujeo is another type of insulin glargine, specifically insulin glargine U300, which has a similar mechanism of action to insulin glargine U100.
Evidence of Lower Hypoglycemia Rates
- Studies have shown that insulin degludec has lower hypoglycemia rates compared to insulin glargine U100 3, 4, 5, 6, 7.
- A meta-analysis of randomized controlled trials found that insulin degludec was associated with a statistically significant reduction in risk for all confirmed hypoglycemia, nocturnal confirmed hypoglycemia, and severe hypoglycemia compared to insulin glargine 7.
- Another study found that treatment with insulin degludec resulted in a relative rate reduction of 36% in nocturnal CGM-recorded hypoglycemia and a 53% reduction in nocturnal CGM-recorded hypoglycemia at a lower detection limit compared to insulin glargine U100 4.
Comparison to Toujeo
- While there are no direct comparisons between Tresiba and Toujeo in the provided studies, the evidence suggests that insulin degludec has lower hypoglycemia rates compared to insulin glargine U100.
- It is unclear whether these findings would translate to a comparison with Toujeo, as Toujeo has a different concentration and formulation than insulin glargine U100.
- Further studies would be needed to directly compare the hypoglycemia rates of Tresiba and Toujeo.