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Diabetes Update: The New Concentrated Insulin Products

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Overview

In the US, approximately 22 million adults are living with diabetes; of these, 90–95% are classified as having type 2 diabetes (T2DM), a progressive disease in which beta cell function declines based on the duration of the disease and level of glycemic control. The American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) both recognize that achieving and maintaining the patient’s glycemic goals are essential for the prevention, or delay in progression, of chronic complications associated with diabetes. However, about half of US adults are not meeting their glycemic goals. Based on the most recent data, 50% of adults with diabetes are taking only oral medications for glycemic control; at least 30% are using insulin, either in combination with oral therapy or as monotherapy. With the rising rates of obesity and T2DM, insulin is emerging as a “sooner rather than later” treatment option.

Why more insulin products? For the past several decades, pharmaceutical companies have attempted to develop insulin formulations that kinetically mimic endogenous insulin secretion. An ideal bolus insulin should have a rapid onset and short duration of action, while an ideal basal insulin would produce smooth or constant plasma levels over a prolonged duration. Although insulin products have improved over the years, there is no product that mimics physiologic insulin secretion exactly.

In 2015, the FDA approved 3 new concentrated insulin products (lispro U-200, glargine U-300, degludec U-200), and in 2016 a new prefilled delivery device for regular U-500 insulin was approved. Compared with neutral protamine Hagedorn (NPH) insulin, the new long-acting products more closely resemble an ideal basal insulin.

Insulin is considered a high-alert medication by the Institute for Safe Medication Practices in both the inpatient and outpatient settings. It is fraught with dosing, dispensing, and administration errors. The emergence of the concentrated insulin products challenges providers to educate both patients and other healthcare professionals about the differences, benefits, practical use, safety, and efficacy of these agents.

Details

Publication Date: 10/20/2016
Expiration Date: 10/20/2019
CE Credit: 1.5 (0.15 CEU)
Type of Activity: Knowledge-based

This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.

Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.

Authors

Jennifer D. Smith, PharmD, CPP, BC-ADM, CDE is an Associate Professor of Pharmacy Practice at Campbell University College of Pharmacy & Health Sciences and a Clinical Pharmacist Practitioner at Wilson Community Health Center. Dr. Smith is the Director of the Pharmacotherapy Clinic at Wilson Community Health Center, which specializes in the education and management of patients with diabetes and related conditions.

Disclosure Statement

Dr. Smith reports no financial relationship with the manufacturer(s) or provider(s) of any commercial product(s) or service(s) that appears in this issue.

Guest Editorial Advisor

Kirby LeeSusan Cornell, BS, Pharm.D, CDE, FAPhA, FAADE is the Associate Director of Experiential Education and Associate Professor in the Department of Pharmacy Practice at Midwestern University Chicago College of Pharmacy. She is also a Certified Diabetes Educator, specializing in community and ambulatory care practice.PharmD, MA, MAS is Associate Professor of Clinical Pharmacy, UCSF School of Pharmacy. His practice focuses on medication management in older adults with cognitive impairment, memory and behavioral changes.

Target Audience

This accredited program is targeted to pharmacists and nurses.

Goals & Objectives

At the conclusion of this program, participants will be able to:

    1. Describe the current blood glucose and A1C treatment goals according to national guidelines, and the role of insulin in managing T2DM.
    2. List potential candidates for concentrated insulin products and the rationale(s) for using these products.
    3. Name the 4 available concentrated insulin products. Describe the pharmacokinetic and clinical properties of each product, and list an advantage of each.
    4. Instruct patients on proper insulin pen use and counsel them on the recognition and management of hypoglycemia.

Accreditation Statements

The Rx Consultant is a publication of Continuing Education Network, Inc.

Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education as a provider of continuing pharmacy education.

Continuing Education Network is approved by the California Board of Registered Nursing, Provider Number CEP 13118. Programs approved by CA BRN are accepted by most State Boards of Nursing.

ACPE Universal Activity Number: 0428-0000-16-008-H01-P


Exam & Credit Statement Procedures

Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and program evaluation.

Editorial and Review Board

Chief Editor and CE Administrator


Terry M. Baker, PharmD

Managing Editor


Tracy Farnen, PharmD

Associate Editors


James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Kaiser Permanente
Oakland, CA

Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA

Richard Ron Finley, B.S. Pharm.,R.Ph.
Clinical Pharmacist (volunteer faculty)
University of California, San Francisco (UCSF) Memory and Aging Center
Lecturer (Emeritus) UCSF, Department of Clinical Pharmacy
Health Sciences Clinical Professor, UCSF School of Pharmacy
San Francisco, CA

Consultant Pharmacist
Ray Dolby Brain Health Center, Sutter Health/CPMC
San Francisco, CA

Consult Pharmacist Aging and Adult Health Services
San Francisco Health Department
San Francisco, CA

Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System

Adjunct Clinical Professor
College of Pharmacy
Touro University
Vallejo, CA

Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Stockton, CA

Visiting Associate Professor and Lecturer
Nursing School
Samuel Merritt University
Oakland, CA

Pamela Mausner, MD

Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Detroit, MI

Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Detroit, MI

Senior Editorial Advisor


Gerard Hatheway, PharmD, PhD

Editorial Advisors


Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD

Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners


Emily K.
Meuleman, RN, C, MS

About the Rx Consultant

The Rx Consultant is a monthly publication dedicated to providing health care professionals with the information they need to educate patients about drugs and manage drug therapy. The reader is responsible for confirming the information presented here and interpreting it in relation to each patient's specific situation before utilizing the information.

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