Highlights

• I prescribe what is available, and obviously that has evolved because as you know, of the basal analogs Lantus was the first one, followed by Levemir and so on, so these days degludec, or Tresiba, would be my preferred one, but of course if there are situations in which the patient cannot afford it, or the payer does not cover it, then I have to go someplace else.
• I mean it [Toujeo] is the same insulin; it is very interesting because Lantus has been losing its market protection, and of course as competition has shown up, Sanofi has been struggling to figure out how to keep their customers, and so Toujeo was a very interesting sort of trick to try and convince everybody that there is something different or new. So, again, look, it is the same insulin, clearly the pharmacokinetics or pharmacodynamics are not identical the way the U300 is packed, but at the same time it is very difficult to demonstrate any advantages.
• There is no question that Tresiba, degludec, is much longer lasting than Levemir. So, as you know, Levemir is approved both for once- and twice-daily injection, Tresiba on the other hand hangs around for 42 hours, so there is never a reason to use Tresiba more than once daily, and the patients do have much more flexibility because it makes no difference when the patients inject Tresiba. So, Levemir, just like the Lantus people, once they made a choice for a specific time of the day, they had to inject the same time every day. Now, I have many patients who might have slight attendance, who are students, who are shift-workers, and people who do not have time, and so for people who have very flexible, unpredictable lives, I think it is very nice to have the option of Tresiba. So, I think Tresiba does provide tangible differences compared to Levemir.