Is Tresiba (insulin degludec) the same as Lantus (insulin glargine)?

Tresiba and Lantus Are Not the Same Insulin

Tresiba (insulin degludec) and Lantus (insulin glargine) are both long-acting basal insulins, but they differ significantly in their pharmacokinetic profiles, duration of action, and clinical characteristics.

Key Pharmacologic Differences

• Tresiba has an ultra-long half-life of approximately 25 hours and a duration of action exceeding 42 hours at steady state, compared to Lantus which has a shorter duration of approximately 24 hours 1.
• Insulin degludec forms soluble multihexamer assemblies after subcutaneous injection, creating a depot that results in its ultra-long action profile, whereas insulin glargine precipitates at physiologic pH to create its depot effect 2.
• Tresiba provides a flatter and more stable glucose-lowering effect with reduced pharmacodynamic variability compared to insulin glargine 1, 3.

Clinical Efficacy Comparisons

Glycemic Control

• Both insulins achieve equivalent HbA1c reductions when used in treat-to-target trials in patients with type 1 and type 2 diabetes 4, 3, 5.
• Tresiba produces significantly greater reductions in fasting plasma glucose (FPG) compared to Lantus, with a mean difference of approximately -0.37 mmol/L (about -6.7 mg/dL) 3, 5.
• In the pivotal Study A, the difference in HbA1c reduction between insulin degludec and insulin glargine U-100 was -0.01% with a 95% confidence interval of [-0.14%; 0.11%], demonstrating non-inferiority 4.

Hypoglycemia Risk

• Tresiba is associated with significantly lower rates of nocturnal hypoglycemia compared to Lantus across both type 1 and type 2 diabetes populations 3, 5.
• Meta-analysis data show rate ratios for nocturnal hypoglycemia of 0.83 in type 1 diabetes basal-bolus therapy, 0.64 in insulin-naïve type 2 diabetes, and 0.75 in type 2 diabetes basal-bolus therapy (all P < 0.05) 3.
• Overall hypoglycemia rates are also reduced with Tresiba, with a 9% reduction in overall hypoglycemia and 26% reduction in nocturnal hypoglycemia during the entire treatment period in pooled populations 1.

Dosing Flexibility and Administration

• Tresiba's ultra-long duration of action allows for flexible dose timing, meaning patients can inject at different times each day if needed, whereas Lantus requires administration at the same time daily 1.
• Both insulins are dosed once daily, though Lantus may require twice-daily dosing in some type 1 diabetes patients with high glycemic variability 6.
• Tresiba is available in two formulations: 100 units/mL (U100) and 200 units/mL, with the U200 formulation delivering the same dose in half the injection volume 1.

Day-to-Day Glucose Variability

• Tresiba demonstrates significantly lower day-to-day variability in fasting blood glucose compared to Lantus 7.
• In the I'D GOT trial, the coefficient of variation (CV) of fasting blood glucose was significantly smaller with insulin degludec compared to insulin glargine after 24 weeks of treatment 7.
• This reduced variability translates to more predictable glucose control and may contribute to the lower nocturnal hypoglycemia rates 7.

Insulin Dose Requirements

• Total daily insulin doses are significantly lower with Tresiba in type 1 diabetes basal-bolus therapy and insulin-naïve type 2 diabetes populations 3.
• In Study A, the mean basal insulin dose at week 52 was 29 units for insulin degludec versus 31 units for insulin glargine U-100 4.

Cost-Effectiveness Considerations

• Cost-effectiveness analyses show that insulin degludec versus glargine has an incremental cost-effectiveness ratio of $406,000 per QALY for basal insulin only and $192,000 per QALY for basal plus bolus insulin regimens 8.
• These ratios exceed typical willingness-to-pay thresholds of $50,000-$150,000 per QALY, suggesting that the clinical benefits of reduced hypoglycemia must be weighed against higher acquisition costs 8.

Clinical Bottom Line

While both Tresiba and Lantus are effective basal insulins that achieve similar HbA1c reductions, Tresiba offers distinct advantages including lower nocturnal hypoglycemia rates, greater FPG reduction, reduced glucose variability, and flexible dosing timing. These benefits may be particularly valuable for patients with problematic nocturnal hypoglycemia or those requiring dosing flexibility, though the higher cost must be considered 1, 3, 5.