Endocrine Abstracts

Introduction: Patients with diabetes mellitus require insulin with disease progression to attain or maintain glycaemic targets. Patients and physicians work together to balance the advantages of improved glycaemic control with the risk of hypoglycaemia and increasing regimen complexity. Insulin Degludec (Tresiba) is an ultra-long-acting insulin analogue launched in the UK in March 2013 and is available in two strengths, 100 and 200 units/ml.

Method: Retrospective case note and hospital database review of patients initiated on degludec (Tresiba) at Royal Derby Hospital from December 2013 to January 2016.

Results: Six patients were identified (1 male, 5 females; 5 patients (83.3%)) with T1DM and one patient (16.7%) with T2DM). Mean age: 45.8 (range 19–56). Mean duration of diabetes prior to initiation of Degludec: 18.5 years (range 0.5–40). All patients were on preliminary insulin therapy prior to starting Degludec. Three (50%) patients were prescribed Degludec due to problems with hypoglycaemia (all T1DM). Poor compliance and requirement for basal OD insulin was the rationale for commencing Degludec in 66.6% of patients. In 3 (50%) patients, Insulin glargine was switched to Degludec. In the remaining patients, Biphasic Insulin regime was stopped and basal-bolus regime of Degludec + Novorapid commenced. HbA1c, where available, was reduced in 33.3% and increased in 33.3% of patients post-initiation of Degludec.

Conclusion: Overall, all of our patients were started on Degludec in compliance with NICE guidelines. The number of patients on Degludec is very limited as it is commonly reserved for last choice basal insulin therapy and requires specialist initiation in view of its safety and cost concerns. Nonetheless, this audit is limited by the small cohort of patients and a multi-centre audit is recommended to provide further information regarding Degludec therapy within the population.