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The potential effect of ultra-long insulin degludec on glycemic variability

  • Author Footnotes
    1 Reports receiving lecture fees from Novo Nordisk.
    M. Rodacki
    Correspondence
    Corresponding author at: Av. Alexandre Ferreira 420 apto 403, Lagoa, Rio de Janeiro, RJ, Brazil.
    Footnotes
    1 Reports receiving lecture fees from Novo Nordisk.
    Affiliations
    Universidade Federal do Rio de Janeiro, Medical Clinic Department, Nutrology and Diabetes Unit, Brazil
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  • Author Footnotes
    2 Leader of medical scientific group at Novo Nordisk Brazil in diabetes and obesity area.
    R.M. Carvalho
    Footnotes
    2 Leader of medical scientific group at Novo Nordisk Brazil in diabetes and obesity area.
    Affiliations
    Endocrinologist at Private Office, Brazil
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  • Author Footnotes
    3 Reports receiving fees for serving on an advisory board from Novo Nordisk, Lilly and Aegerion; lecture fees from Novo Nordisk, Lilly, Sanofi, and Mantecorp.
    L. Zajdenverg
    Footnotes
    3 Reports receiving fees for serving on an advisory board from Novo Nordisk, Lilly and Aegerion; lecture fees from Novo Nordisk, Lilly, Sanofi, and Mantecorp.
    Affiliations
    Universidade Federal do Rio de Janeiro, Medical Clinic Department, Nutrology and Diabetes Unit, Brazil
    Search for articles by this author
  • Author Footnotes
    1 Reports receiving lecture fees from Novo Nordisk.
    2 Leader of medical scientific group at Novo Nordisk Brazil in diabetes and obesity area.
    3 Reports receiving fees for serving on an advisory board from Novo Nordisk, Lilly and Aegerion; lecture fees from Novo Nordisk, Lilly, Sanofi, and Mantecorp.

      Abstract

      Despite the therapeutic advances in the treatment of diabetes, metabolic control instability due to glycemic variability (GV) is frequently observed in patients with diabetes on intensive insulin therapy and is associated with hyperglycemic peaks and hypoglycemic episodes. Hyperglycemia associated with GV has been implicated in the development of chronic complications due to its pro-oxidative consequences. On the other hand, hypoglycemia can be associated with increased cardiovascular risk secondarily to adrenergic activation. The ultra-long-acting insulin analogue, insulin degludec (IDeg), presents a flat and stable glucose-lowering effect both in Type 1 and Type 2 diabetes patients. In pharmacodynamic studies, IDeg has been associated with a lower variability in its insulin action than other alternatives for basal insulin, which might have clinical advantages for the stability of the glycemic control. The main objective of this review is to present pharmacological and clinical data regarding the efficacy and safety of IDeg for the treatment of diabetes focusing on its effects on GV and on hypoglycemia frequency.

      Abbreviations:

      1,5-AG (1,5-anhydroglucitol), AUC (area under curve), CGM (Continuous Glucose Monitoring), CI (confidence interval), CONGAn (Continuous Overlapping Net Glycemic Action), CV (Coefficient of Variance), DCCT (Diabetes Control and Complication Trial), FPG (fasting plasma glucose), GIR (glucose infusion rate), GV (glycemic variability), IDeg (insulin degludec), IGlar (insulin glargine), IQR (Interquartile Range), MAG (Mean Absolute Glucose), MAGE (Mean Amplitude of Glucose Excursion, MODD, Mean of Daily Differences), MODD (Mean of Daily Differences), OAD (once a day), PD (Pharmacodynamic), PK (Pharmacokinetic), RMSE (Root-Mean-Square Error), ROS (Reactive Oxygen Species), RR (Rate Ratio), s.c. (subcutaneous), SD (Standard Deviation), SMBG (Self-monitoring of Blood Glucose), T1D (Type 1 Diabetes), T1DB/B (T1D patients receiving basal–bolus therapy), T2D (Type 2 Diabetes), T2Dinsulin-naïve (T2D insulin-naïve T2D), T2DB/B (T2D patients receiving basal–bolus therapy)

      Keywords

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