What is the conversion from Tresiba (insulin degludec) to Basaglar (insulin glargine)?

From the Guidelines

When converting from Tresiba to Basaglar, a 1:1 unit conversion is generally recommended as a starting point, with subsequent adjustments based on glucose monitoring, and consideration of an initial 10-20% dose reduction for individuals at high risk for hypoglycemia. This approach is supported by the latest guidelines on pharmacologic approaches to glycemic treatment, which emphasize the importance of understanding how to convert individuals from one basal insulin to another due to various clinical scenarios 1.

Key Considerations for Conversion

• The conversion should be supervised by a healthcare provider who can adjust the dose based on blood glucose monitoring results.
• Patients should be advised to maintain consistent timing of their Basaglar injection, preferably at the same time each day.
• Patients should be educated about potential differences in hypoglycemia risk during the transition period and instructed to monitor for symptoms closely.
• Clinical signals such as high bedtime-to-morning or preprandial-to-postprandial glucose differential, hypoglycemia, and high glucose variability should prompt evaluation for overbasalization and reevaluation of the glucose-lowering treatment plan 1.

Adjusting the Dose

• The initial dose may need to be adjusted based on individual responses to the new insulin, considering factors such as the difference in duration of action between Tresiba and Basaglar.
• An initial dose reduction of 10–20% can be considered for individuals in very tight management or at high risk for hypoglycemia, especially when switching from insulins like U-300 glargine to another insulin 1.

Monitoring and Follow-Up

• Close monitoring of blood glucose levels is essential after the switch to identify any need for dose adjustments and to minimize the risk of hypoglycemia or hyperglycemia.
• Healthcare providers should be prepared to make adjustments to the Basaglar dose based on the patient's glucose monitoring results to achieve and maintain glycemic goals, as outlined in the standards of care in diabetes-2025 1.

From the FDA Drug Label

The efficacy of Insulin Degludec administered once-daily either at the same time each day or at any time each day in patients with type 1 diabetes and used in combination with a mealtime insulin was evaluated in three randomized, open-label, treat-to-target, active-controlled trials in adults and one randomized, open-label, treat-to-target, active-controlled trial in pediatric patients 1 year of age and older. Adult patients treated with Insulin Degludec achieved levels of glycemic control similar to those achieved with LANTUS (insulin glargine 100 units/mL) and LEVEMIR (insulin detemir) and achieved statistically significant improvements compared to sitagliptin.

The FDA drug label does not provide direct information on converting Tresiba to Basaglar.

• Key points:
  • Tresiba (insulin degludec) and Basaglar (insulin glargine) are both long-acting insulins.
  • The label provides information on the efficacy of Tresiba compared to LANTUS (insulin glargine 100 units/mL) and LEVEMIR (insulin detemir).
  • However, it does not provide specific guidance on converting from Tresiba to Basaglar.
  • Clinicians should exercise caution when switching between different insulin products, as this may require adjustments to dosing and monitoring to ensure optimal glycemic control 2.

From the Research

Tresiba to Basaglar Conversion

• Tresiba (insulin degludec) and Basaglar (insulin glargine) are both long-acting insulins used to control blood sugar levels in patients with diabetes.
• When converting from Tresiba to Basaglar, it is essential to consider the differences in their pharmacokinetic and pharmacodynamic profiles 3, 4.
• Studies have shown that insulin degludec (Tresiba) has a lower risk of hypoglycemia compared to insulin glargine (Basaglar) in patients with type 1 and type 2 diabetes 3, 4, 5, 6.
• A randomized, double-blind, treat-to-target crossover trial (SWITCH 2) found that insulin degludec resulted in a reduced rate of overall symptomatic hypoglycemia compared to insulin glargine U100 in patients with type 2 diabetes 3.
• Another study (CONCLUDE trial) found that insulin degludec had a lower rate of nocturnal symptomatic hypoglycaemia and severe hypoglycaemia compared to insulin glargine U300 in patients with type 2 diabetes 6.
• When converting from Tresiba to Basaglar, the dosage should be individualized based on the patient's specific needs and glucose control goals.
• It is crucial to monitor blood glucose levels closely during the conversion period to adjust the dosage as needed and minimize the risk of hypoglycemia or hyperglycemia 7, 5.

Key Considerations

• Insulin degludec (Tresiba) has a flat and stable glucose-lowering effect, which may reduce the risk of hypoglycemia compared to insulin glargine (Basaglar) 3, 4.
• The conversion ratio from Tresiba to Basaglar is generally 1:1, but this may vary depending on the individual patient's needs and response to treatment 6.
• Patients should be educated on the proper use of insulin, glucose monitoring, and hypoglycemia management to ensure a safe and effective conversion from Tresiba to Basaglar 7, 5.

Clinical Implications

• Healthcare providers should carefully evaluate the benefits and risks of converting patients from Tresiba to Basaglar, considering individual patient factors and glucose control goals 3, 4, 6.
• Close monitoring of blood glucose levels and adjustment of the insulin dosage as needed can help minimize the risk of hypoglycemia or hyperglycemia during the conversion period 7, 5.