A New Long-Acting Insulin OptionFriday, April 17, 2015
The FDA has recently approved Toujeo (insulin glargine injection), which is a long-acting insulin containing 300 Units/mL of insulin glargine. This insulin product comes in a 1.5ml pen that contains 450 units. Toujeo, a basal insulin, is approved for the improvement of glycemic control in adults with type 1 and type 2 diabetes.
Toujeo Solostar, a disposable prefilled pen, is good in room temperature for a period of 28 days and can be administered once daily in the morning (time period covering from pre-breakfast until pre-lunch) or in the evening (time period defined as prior to the evening meal until at bedtime).
Toujeo is a clear solution and should not be mixed with any other insulin product. This formulation of glargine insulin is said to have an onset of action of 6 hours and it’s full glucose lowering effect may not be apparent for at least 5 days. Here is some information for both people just beginning an insulin regimen and for those who are experienced insulin users.
Starting Dose in Insulin-Naïve Patients:
- In patients with type 1 diabetes is approximately one-third to one-half of the total daily insulin dose or 0.2 to 0.4 units/Kg once daily
- In patients with type 2 diabetes is 0.2 units/Kg daily.
Starting Dose for Experienced Patients on Insulin:
- The starting dose of Toujeo can be the same as the once daily long-acting dose
- The recommended starting toujeo dose is 80% of the total daily NPH dosage.
Clinical trials evaluated Toujeo (insulin glargine 300u/ml) and compared it to insulin glargine 100u/ml in both type 1 and type 2 diabetes patients for a period up to 26 weeks. In these studies the different concentrations of insulin glargine were added to meal-time insulin in patients with type 1 diabetes and non-insulin antidiabetic medications in patients with type 2 diabetes.
The clinical trials reported the following results:
- No clinically important differences in glycemic control when Toujeo was administered once daily as a morning dose compared with an evening dose
- No clinically important differences in body weight between treatment groups
- Significant A1c improvement: toujeo group >lantus group
- Comparable reduction in fasting blood glucose in toujeo group vs. lantus group
- Common adverse events (excluding hypoglycemia) reported for Toujeo included Nasopharyngitis and Upper respiratory tract infection.
Despite the proven efficacy of different basal insulin products, ensuring effective titration and maintenance can be challenging. As a clinician, I often stumble upon patients that may require significantly high doses of once daily basal insulin or even twice daily long-acting basal insulin products to improve glycemic control.
Toujeo, at three times the concentration and with a design to release the insulin more gradually, can provide good glycemic control with lower rates of hypoglycemia. Accidental mix-ups between basal insulin products can be a source of medication errors. To avoid medication errors between toujeo and other insulin products, instruct patients to always check the insulin label before each injection. The "300 Units/mL (U-300)" is highlighted in honey gold on the label of Toujeo SoloStar disposable prefilled pen.
With proper education, I believe that Toujeo will bring another option to patients with diabetes that will improve medication compliance and improve glycemic control.