Final week, Novo Nordisk introduced that it plans to discontinue gross sales of Levemir in the US. Folks with diabetes who use Levemir ought to plan now on transitioning to another.
Levemir is available in two kinds, a vial and a “FlexPen.” FlexPen customers should change first: the producer states that provide disruptions will start in mid-January 2024 and that the medicine might be discontinued fully by April 1, 2024. Those that use Levemir in a vial have an extended time to transition: vials could also be obtainable till the top of 2024.
Why is Levemir going away? In an announcement, the producer defined that Levemir can be discontinued “on account of international manufacturing constraints, formulary losses impacting affected person entry, and the provision of other choices.”
It’s attainable that Levemir gross sales have flagged after the introduction of quite a lot of lower-cost variations of a rival basal insulin, insulin glargine. Levemir prescriptions have dropped 23 p.c within the final yr, in keeping with SingleCare, a web based prescription financial savings service.
It’s also attainable that Novo Nordisk needs to reinforce gross sales of its different (dearer) long-acting insulin, Tresiba. Or maybe the pharmaceutical large needs to dedicate extra of its manufacturing capability to the blockbusters Ozempic and Wegovy, which are available an analogous injector pen system.
On social media, some members of the diabetes group responded with skepticism. The non-profit T1International known as the transfer “indefensible.” Others commented that Levemir was the one basal insulin on their insurance coverage formulary, and feared that the change would imply a multitude of pink tape and better prices.
Regardless of the causes, this text will attempt to assist make sense of the transition that Levemir customers could must make.
Different Choices for Type 1 Diabetes
For individuals with sort 1 diabetes, who’ve an absolute want of insulin, Levemir customers will undoubtedly have to change to a different long-acting insulin. Listed below are the choices:
- Lantus (insulin glargine) — The nation’s best-selling long-acting insulin
- Basalgar (insulin glargine) — An alternate that’s basically an identical to Lantus
- Rezvoglar (insulin glargine) — A “biosimilar” that’s basically an identical to Lantus
- Semglee (insulin glargine) — A “biosimilar” that’s basically an identical to Lantus
- Toujeo (insulin glargine) — a super-concentrated type of insulin glargine, that energetic ingredient in Lantus, primarily used for sufferers that require bigger doses
- Tresiba (insulin degludec) — Novo Nordisk’s different long-acting insulin, Tresiba lasts even longer than Levemir, which can improve dose timing flexibility
- NPH (isophane insulin) — an intermediate-acting insulin. NPH is cheap however more difficult to make use of than Tresiba and will include the next threat of hypoglycemia.
It’s vital to talk to your physician (and work along with your insurer) to be taught which insulins can be reasonably priced and work greatest for you. Inexpensive unbranded alternate options may additionally be obtainable.
Levemir’s discontinuation may additionally be an opportune time to debate an insulin pump, which makes use of solely speedy insulin.
Most sufferers switching from Levemir (insulin detemir) will start utilizing insulin glargine (Lantus and its many equivalents) or insulin degludec (Tresiba).
The Annals of Medication has revealed a sensible steerage for healthcare practitioners on change basal insulins safely. In lots of instances, basal insulin dosages look like completely interchangeable between formulations, that means that you simply gained’t want to vary the quantity of insulin you are taking when switching. However the steerage states that “dose adjustment could also be wanted if switching from detemir to glargine,” which might be related to the massive variety of individuals switching from Levemir to any insulin within the Lantus household. Specialists advocate performing further blood glucose monitoring through the first weeks of transition.
Particular warning is required when switching from Levemir to NPH, which has a really totally different motion curve.
Any change of insulins must be completed solely below the steerage of your medical group. The Diabetes Every day discussion board can be full of fine recommendation from those that have switched insulin formulations up to now.
Different Choices for Type 2 Diabetes
Folks with sort 2 diabetes who require a basal insulin could also be suggested to change to another insulin listed within the earlier part.
Clinicians could need to take into account non-insulin alternate options, too. In recent times, sort 2 diabetes authorities have systematically de-emphasized the usage of insulin in favor of each GLP-1 receptor agonists and SGLT2 inhibitors, newer drugs which might help enhance excessive blood sugars however add further advantages that insulin can’t: weight reduction, coronary heart and kidney safety, and a lowered threat of hypoglycemia.
Novo Nordisk’s personal GLP-1, semaglutide (Ozempic), has rapidly develop into the world’s largest diabetes and weight reduction blockbuster, and plenty of clinicians are transitioning their sufferers away from insulin and onto Ozempic or comparable medication resembling dulaglutide (Trulicity) or tirzepatide (Mounjaro). Insulin has more and more been seen as a final resort for individuals with sort 2 diabetes — it might be time to debate non-insulin alternate options along with your medical supplier.