Possibilities of using insulin degludec in the treatment of diabetes mellitus in patients with previous ineffective insulin therapy: analysis of clinical cases

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Abstract

Achieving and maintaining target values of glycemic control remains an urgent task in the treatment of patients with both type 1 diabetes mellitus (DM1) and type 2 diabetes mellitus (DM2). At the present stage, in addition to the glycated hemoglobin level, new indicators of glucose control have appeared associated with the introduction of the method of continuous glucose monitoring in patients. Particular attention is paid to the indicators of glycemic variability (GV). In DM1 patients, therapy with intermediate-acting insulins and their peak-acting analogues does not fully mimic endogenous insulin secretion, increases the risk of hypoglycemia and may be associated with an increased incidence of GV. DM2 patients more often require higher doses of insulin, the use of which is also associated with high GV. GV can be considered as a risk factor for hypoglycemia and vascular complications. The emergence of new-generation insulins with a long action that do not have an absorption peak can reduce GV. Insulin degludec (Tresiba®) is a long-acting basal insulin analogue (with an action duration of more than 42 hours), which was specially developed for low variability of action. This article considers a series of clinical cases of DM1 and DM2 patients being switched to insulin degludec therapy due to ineffective previous treatment with insulin detemir.

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About the authors

O. S. Elsukova

Kirov State Medical University; Yurlova Kirov Clinical Hospital No. 7

Author for correspondence.
Email: oselsukova@mail.ru
ORCID iD: 0000-0002-2341-9491

Cand. Sci. (Med.), Associate Professor at the Department of Hospital Therapy; Head of the Endocrinology Department of the Regional Endocrinology Center

Russian Federation, Kirov; Kirov

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2. Fig. 1. Flash monitoring data of Patient C. on the background of therapy: metformin 2000 mg, sitagliptin, insulin detemir 30 units in the morning and 36 units in the evening

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3. Fig. 2. Flash monitoring data of Patient C. on the background of therapy: metformin 2000 mg, sitagliptin, insulin detemir 30 units in the morning and 36 units in the evening

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4. Fig. 3. Flash monitoring data of Patient C. on the background of therapy: metformin 2000 mg, sitagliptin, insulin detemir 30 units in the morning and 36 units in the evening

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5. Fig. 4. Flash monitoring data of Patient C. on the background of therapy: metformin 2000 mg, sitagliptin, insulin degludec 40 units in the evening

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6. Fig. 5. Flash monitoring data after Patient C. on the background of therapy: metformin 2000 mg, sitagliptin, insulin degludec 40 units in the evening

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7. Fig. 6. Flash-monitoring data of Patient I. on the background of therapy: insulin detemir 8 units in the morning and 12 units in the evening, insulin lispro at 1:1 CC

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8. Fig. 7. Flash-monitoring data of Patient I. on the background of therapy: insulin detemir 8 units in the morning and 12 units in the evening, insulin lispro at 1:1 CC

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9. Fig. 8. Flash-monitoring data of Patient I. on the background of therapy: insulin degludec 13 units in the evening, insulin lispro at 1:1 CC

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10. Fig. 9. Flash-monitoring data of Patient D. on the background of therapy: insulin glargine U100 30 units in the evening, insulin aspart by 1CC:2 units CC

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11. Fig. 10. Flash-monitoring data of Patient D. on the background of therapy: insulin degludec 16 units in the evening, insulin aspart by CC

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12. Fig. 11. Flash-monitoring data of Patient D. on the background of therapy: insulin glargine U100 30 units in the evening, insulin aspart by 1CC:2 units CC

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