Tresiba (Insulin Degludec) as a Long-Acting Insulin
Yes, Tresiba (insulin degludec) is a long-acting insulin analog with an ultra-long duration of action exceeding 42 hours.
Classification and Pharmacokinetics
Tresiba (insulin degludec) belongs to the category of long-acting insulin analogs, specifically classified as an ultra-long-acting insulin due to its extended duration of action. According to the American Diabetes Association and European Association for the Study of Diabetes, insulin degludec is considered a basal insulin with the following characteristics 1, 2:
- Onset of action: 1-2 hours
- Peak effect: Minimal peak (flatter profile than other insulins)
- Duration of action: >42 hours (longer than other long-acting insulins)
- Available concentrations: U-100 and U-200 formulations
Comparison with Other Basal Insulins
Tresiba differs from other basal insulins in several important ways:
- Longer duration: Insulin degludec has a significantly longer half-life (>25 hours) and duration of action (>42 hours) compared to other long-acting insulins like glargine and detemir 3
- Stability of effect: It provides a more constant glucose-lowering effect with less day-to-day variability than insulin glargine 4
- Mechanism: It has a unique mechanism involving formation of soluble multihexamer chains after subcutaneous injection, creating a depot that slowly releases insulin 3
Clinical Advantages
The ultra-long duration of Tresiba offers several potential clinical benefits:
- Reduced hypoglycemia risk: Clinical trials have demonstrated a lower risk of nocturnal hypoglycemia compared to insulin glargine 4, 3
- Flexible dosing: The extended duration allows for more flexible administration times without compromising glycemic control, with the possibility of varying injection times by 8-40 hours 5, 6
- Concentrated formulation: Available as U-200 formulation (200 units/mL) for patients requiring large doses of insulin, reducing injection volume 2, 4
Practical Considerations
When using Tresiba (insulin degludec), healthcare providers should consider:
- It can be administered once daily at any time of day, but should be given at approximately the same time each day for optimal effect 2
- The American Diabetes Association recognizes it as an appropriate basal insulin option for both type 1 and type 2 diabetes 1
- Like other long-acting insulin analogs, it has a modestly lower absolute risk for hypoglycemia compared with NPH insulin, but at a higher cost 1
Cautions
- The U-200 formulation creates a potential risk of dosing errors due to the different concentration compared to standard U-100 insulins 5
- Limited data exists on its use during pregnancy 5
- Some research has suggested potential cardiovascular concerns that warrant further investigation 5
In conclusion, Tresiba (insulin degludec) is definitively classified as a long-acting insulin analog with ultra-long duration of action, making it suitable for once-daily basal insulin therapy in patients with diabetes.