Is Toujeo Longer Acting Than Lantus?
Yes, Toujeo (insulin glargine U-300) has a longer duration of action than Lantus (insulin glargine U-100), with glucose-lowering activity exceeding 24 hours and a flatter, more prolonged pharmacokinetic profile. 1
Pharmacokinetic Differences
U-300 glargine (Toujeo) demonstrates a more stable and prolonged pharmacokinetic/pharmacodynamic profile compared to U-100 glargine (Lantus), with duration of glucose-lowering activity exceeding 24 hours. 2 The concentrated formulation creates a smaller subcutaneous depot surface area relative to volume, resulting in slower and more prolonged insulin release. 3
Key pharmacokinetic advantages of Toujeo include:
- Flatter insulin concentration profile with less peak-to-trough variation 3, 4
- Lower intra- and inter-day variability, making insulin action more reproducible 3
- Duration of action consistently beyond 24 hours, compared to Lantus which may not provide full 24-hour coverage in all patients 2, 4
Clinical Implications
Dosing Considerations
U-300 glargine has modestly lower efficacy per unit administered compared to U-100 glargine, requiring approximately 10-18% higher daily doses to achieve equivalent glycemic control. 1, 5 This is not a treatment failure but rather reflects the different pharmacokinetic properties of the concentrated formulation. 3
Hypoglycemia Risk
In insulin-experienced patients with type 2 diabetes, Toujeo is associated with lower risk of nocturnal hypoglycemia compared to Lantus. 2, 4 This benefit is most pronounced during the maintenance phase of therapy (weeks 9 through month 6). 4 However, in insulin-naïve patients with type 2 diabetes and in patients with type 1 diabetes, the nocturnal hypoglycemia risk did not significantly differ between formulations. 2
Practical Advantages
The longer duration of action provides:
- Greater flexibility in injection timing without compromising glycemic control 3
- More consistent basal insulin coverage for patients requiring doses at the upper end of the therapeutic range 5
- Reduced volume per injection for patients requiring large insulin doses, potentially improving comfort and adherence 1, 5
Important Caveats
The two formulations are not bioequivalent and cannot be substituted unit-for-unit. 3 When switching from Lantus to Toujeo, expect to increase the total daily basal insulin dose, and intensify blood glucose monitoring during the transition period. 3
Despite the longer duration of action, Toujeo achieves comparable—not superior—glycemic control (HbA1c reduction) compared to Lantus in clinical trials. 2, 4 The primary clinical advantage is the reduced nocturnal hypoglycemia risk in specific patient populations, not improved efficacy. 2