What are alternative long-acting insulins similar to Lantus (insulin glargine)?

From the Guidelines

Alternative long-acting insulins similar to Lantus (insulin glargine) include Levemir (insulin detemir), Toujeo (concentrated insulin glargine U-300), Tresiba (insulin degludec), Basaglar, and Semglee (both biosimilar versions of insulin glargine). These medications all serve as basal insulins that provide steady, background insulin levels for 24 hours or longer. According to the most recent study 1, long-acting basal analogs (U-100 glargine and detemir) have been demonstrated to reduce the risk of level 2 hypoglycemia and nocturnal hypoglycemia compared with NPH insulin.

Key Characteristics of Alternative Long-Acting Insulins

• Levemir typically lasts 18-24 hours and may require twice-daily dosing for some patients.
• Toujeo provides more stable blood glucose control with less risk of overnight hypoglycemia compared to standard Lantus.
• Tresiba has the longest duration of action (up to 42 hours) and offers flexible dosing times.
• Basaglar and Semglee work similarly to Lantus but are generally more affordable.

Administration and Dosage

All these insulins are administered by subcutaneous injection, typically once daily, with starting doses often based on weight (0.1-0.2 units/kg/day) and adjusted according to blood glucose readings. As noted in 1, doses can be converted unit for unit and subsequently adjusted based on glucose monitoring, but an initial dose reduction of 10–20% can be used for individuals in very tight management or at high risk for hypoglycemia.

Mechanism of Action

These alternatives work by slowing glucose release from the liver and promoting glucose uptake in peripheral tissues, maintaining baseline blood sugar control between meals and overnight, as described in 1 and further supported by 1 and 1. The choice among these alternatives should consider factors such as duration of action, risk of hypoglycemia, flexibility of dosing, and cost, with the goal of optimizing glycemic control while minimizing adverse effects, as emphasized in 1.

From the FDA Drug Label

SEMGLEE (insulin glargine-yfgn) is interchangeable* with LANTUS (insulin glargine).

• An interchangeable product (IP) is a biological product that is approved based on data demonstrating that it is highly similar to an FDA-approved reference product (RP) and that there are no clinically meaningful differences between the products; it can be expected to produce the same clinical result as the RP in any given patient; and if administered more than once to a patient, the risk in terms of safety or diminished efficacy from alternating or switching between use of the RP and IP is not greater than that from the RP without such alternation or switch.

Alternative long-acting insulins similar to Lantus (insulin glargine) include:

• Insulin glargine-yfgn (SEMGLEE) 2
• Insulin degludec is another long-acting insulin, but the provided labels do not specify its interchangeability with Lantus (insulin glargine) 2

Note: The FDA label for insulin degludec does not provide information on its similarity or interchangeability with Lantus (insulin glargine).

From the Research

Alternative Long-Acting Insulins

There are several alternative long-acting insulins similar to Lantus (insulin glargine) available for the management of type 1 and type 2 diabetes. Some of these alternatives include:

• Insulin detemir: a long-acting insulin analogue with a lower within-subject variability of fasting plasma glucose levels compared to NPH insulin and insulin glargine 3
• Insulin degludec: an ultralong-acting insulin analogue with a flat and reproducible pharmacodynamic profile, providing a lower risk of hypoglycemia compared to insulin glargine U100 4, 5
• Insulin glargine U300: a concentrated formulation of insulin glargine, providing a flatter profile and increased window of administration compared to insulin glargine U100 6

Comparison of Alternative Insulins

Studies have compared the efficacy and safety of these alternative insulins to insulin glargine, with results showing:

• Insulin detemir has similar glucose-lowering efficacy to NPH insulin, but with a lower risk of hypoglycemia, particularly during nighttime 7, 3
• Insulin degludec has non-inferior efficacy to insulin glargine U100, with a lower risk of hypoglycemia, particularly nocturnal hypoglycemia 4, 5
• Insulin glargine U300 has non-inferior efficacy to insulin glargine U100, with a lower risk of severe or nocturnal hypoglycemia 6

Patient Considerations

When considering alternative long-acting insulins, patient factors such as:

• Recurrent or increased risk of hypoglycemia
• Age and living situation (e.g. elderly or living alone)
• Multiple co-morbidities (e.g. cardiovascular or renal disease) should be taken into account, as certain insulins may be more suitable for specific patient groups 6