Transition of patients to and from insulin degludec: A clinical challenge

Abstract

With appearance of new insulins on the market, new clinical challenges, much like unintendedconsequences, came into light in our daily practice. One of the most pressing issues has becomean issue of switching patients to and from newer insulins in various clinical situations. A properswitch from 1 medication to another requires understanding of pharmacokinetics (PK) andpharmacodynamics (PD) of both drugs. Unfortunately, there is no research in this area and, asa result, there are no guidelines nor is there even a consensus. We present 5 clinical scenariosin which the patients were transitioned to or from insulin degludec. Because there are nodata and no current consensus, we have polled 200 diabetes care providers soliciting theiropinion as to how they would handle these clinical situations. Our poll of endocrinologistsrevealed multiple approaches as well as elements of confusion among providers. Even thoughall answers, summarized following each case, might be reasonable, and there might not bea single correct answer, we wish to express our opinion that is based on PK and PD of theseinsulins. Because there is more than 1 correct way of implementing these transitions, we urgeour colleagues to institute a very close follow-up of these patients with frequent adjustmentsof insulin dose to avoid stacking with potential hypoglycemia.