Insulin Degludec Classification
Insulin degludec is an ultra-long-acting basal insulin analog with a duration of action exceeding 42 hours, providing flat and stable glucose-lowering effects for more than 24 hours. 1
Pharmacokinetic Profile
Degludec delivers a "peakless" action profile that extends beyond 42 hours in adults, substantially longer than conventional basal insulin formulations like NPH insulin or insulin glargine U-100. 2, 3
The ultra-long duration creates flat, stable plasma concentrations with less within-patient day-to-day variability in glucose-lowering effect compared to insulin glargine. 4
Degludec has an onset of approximately 1 hour with an ultra-long duration exceeding 42 hours, contrasting with glargine's approximately 24-hour duration. 5
Clinical Classification Context
The American Diabetes Association categorizes degludec among "new longer-acting basal analogs" alongside U-300 glargine, distinguishing these from earlier basal insulin analogs (U-100 glargine, detemir) and intermediate-acting insulins (NPH). 1
Degludec is available in two concentrations: U-100 formulation in cartridges and U-200 formulation in prefilled pens, with the U-200 formulation having pharmacokinetics similar to U-100 but allowing higher doses per volume. 1
Hypoglycemia Risk Profile
Degludec may confer lower hypoglycemia risk compared to U-100 glargine in individuals with type 1 diabetes, with nocturnal confirmed hypoglycemia reduced by approximately 25% in clinical trials. 1, 2
In type 2 diabetes, overall confirmed hypoglycemia was 18% lower and nocturnal confirmed hypoglycemia was 25% lower with degludec compared to glargine. 2
Dosing Flexibility
Unlike glargine, which requires administration at a consistent time each day, degludec can be administered at varying times of day without loss of efficacy due to its ultra-long half-life. 5, 6
This flexible dosing capability distinguishes degludec from other basal insulins and may enhance patient adherence when daily routines are irregular. 6
Common Pitfalls
Do not assume degludec's longer duration automatically justifies its use—cost-effectiveness analyses show degludec costs approximately $406,000 per quality-adjusted life-year gained when used as basal-only therapy compared to glargine, indicating low value for most patients. 1
The absolute reduction in nocturnal hypoglycemia (approximately 0.14 fewer episodes per patient-year) may not outweigh the 20% cost premium over glargine for standard-risk patients. 7
Degludec U-200 formulations are available only in prefilled pens to minimize dosing errors; prescribing vials requires specific U-500 syringes to prevent medication errors. 1