Not bioequivalent to insulin glargine 100 U per ml: remember to adjust the dose when switching from one concentration to the other. Insulin products dosed at 200 units per millilitre have been authorised in the European Union since 2013, even though they have no advantages over the previous standard concentration of 100 units per ml (1). In 2016, insulin glargine, a long-acting analogue of human insulin, is available at a new concentration of 300 units per ml (Toujeo0, Sanofi Aventis) and is marketed alongside the existing concentration of 100 units per ml (Lantus0). Four unblinded, randomised, non-inferiority trials in a total of about 3000 patients with type 1 or 2 diabetes showed that the impact of insulin glargine 300 units per ml on the HbA1c level was similar to that of insulin glargine 100 units per ml. Overall, the frequency of severe hypoglycaemia was similar with the two concentrations (2). One unit of Toujeo0 corresponds to one unit of insulin Lantus0, but the two products are not bioequivalent, meaning that a dose modification is sometimes necessary when switching from one to the other. The EU summary of product characteristics states that the difference can reach 20%. Adequate patient information and intensified glucose monitoring are necessary (2,3).
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