Do Tresiba (insulin degludec) and Lantus (insulin glargine) act in the same way?

Tresiba and Lantus: Similarities and Differences in Mechanism of Action

Tresiba (insulin degludec) and Lantus (insulin glargine) are both long-acting basal insulin analogs that work similarly to control blood glucose, but Tresiba has a longer duration of action (>24 hours) compared to Lantus (up to 24 hours), offering more flexibility in dosing time.

Basic Mechanism of Action

• Both Tresiba and Lantus are basal insulin analogs designed to provide relatively constant, peakless insulin levels to control blood glucose between meals and overnight 1
• Both medications work primarily by restraining hepatic glucose production and limiting hyperglycemia overnight and between meals 1
• Both are recombinant DNA-derived insulin analogs that have been modified from human insulin to change their onset and duration of action 1

Pharmacokinetic Differences

• Duration of action: Tresiba (insulin degludec) has a longer duration of action (>24 hours) compared to Lantus (insulin glargine), which has a duration of up to 24 hours 1, 2
• Tresiba has a half-life of approximately 25 hours, while Lantus has a shorter half-life 2
• Tresiba provides a more stable glucose-lowering effect with less variability in insulin levels over 24 hours 2, 3

Clinical Implications of Differences

• Dosing flexibility: Due to its longer duration of action, Tresiba offers a broader dosing window, allowing for more flexible administration times when needed 2, 3
• Both insulins are typically administered once daily, but Tresiba's longer action profile may provide more consistent coverage for patients who occasionally miss their usual dosing time 2
• Clinical trials have shown that both insulins achieve similar glycemic control (HbA1c reduction) when compared head-to-head 4

Hypoglycemia Risk

• Long-acting insulin analogs like Tresiba and Lantus both have a modestly lower risk of hypoglycemia compared to older intermediate-acting insulins like NPH 1
• Some studies suggest Tresiba may have a slightly lower risk of nocturnal hypoglycemia compared to Lantus, though this advantage may be modest in real-world settings 2, 3

Formulation Options

• Both insulins are available in different concentrations:
  • Tresiba comes in U-100 and U-200 formulations 1
  • Lantus comes in U-100 and U-300 (Toujeo) formulations 1
• The higher concentration formulations allow delivery of larger doses in smaller volumes, potentially improving absorption 3

Important Considerations for Clinical Use

• When switching between these insulins, doses can often be converted unit-for-unit, but an initial dose reduction of 10-20% may be needed for patients at high risk of hypoglycemia 1
• Both insulins can be used in combination with mealtime insulin in type 1 diabetes or with oral medications in type 2 diabetes 1
• The choice between Tresiba and Lantus should consider factors like dosing flexibility needs, risk of hypoglycemia, and cost 1, 3

Conclusion

While Tresiba and Lantus act through the same basic mechanism as basal insulins, Tresiba's longer duration of action and more stable pharmacokinetic profile may offer advantages for certain patients, particularly those who need dosing flexibility or have concerns about nocturnal hypoglycemia.