Recently, insulin degludec (Novo Nordisk A/S, Bagsværd, Denmark), a soluble dihexamer preparation that forms stable and soluble multihexamers after subcutaneous injection, has been developed [4]. The multihexamers remain at the injection site for some time and gradually dissolve to release insulin monomers into the blood in a slow and sustained manner PI3K inhibitor [4]. Degludec has prolonged activity as it binds to albumin via fatty acid side chains both at the subcutaneous injection site and in the blood [4]. In 22 Japanese patients with T1DM who received subcutaneous administration of insulin degludec at 0.4 units

(U)/kg once daily for 6 days, the duration of action was reported to be over 26 h [5]. In our previous study, we showed that it was possible to achieve similar glycemic control by once-daily injection of a lower dose of insulin degludec in patients with T1DM who had been treated with insulin glargine or detemir twice

daily [6]. Another study reported that insulin degludec lessens day-to-day variability of blood glucose levels as compared with insulin glargine [7]. However, there is no report on the medium-term effects of insulin degludec on glucose fluctuation and nocturnal hypoglycemia in patients with T1DM. This is a follow-up of our previous study on insulin degludec Dabrafenib concentration [6]. The aim of this study was to analyze the medium-term effects of switching from insulin glargine or detemir to insulin degludec on daily blood glucose fluctuation, glycated hemoglobin (HbA1c), and total daily insulin dose (TDD). 2 Methods 2.1 Subjects In our previous study, ten patients were treated with twice-daily injection of insulin glargine or detemir. However, three patients refused to undergo continuous glucose monitoring (CGM) 24 weeks after switching for personal reasons. The subjects of this study were seven patients (three males and four females) with T1DM who had been treated with MDI therapy for over 12 months at the Division of Diabetes, Endocrinology,

and Metabolism, Department of Internal Medicine, Hyogo College of Medicine (Hyogo, Japan). else Inclusion criteria were treatment with insulin glargine or detemir as basal insulin therapy, HbA1c of ≥6.0 %, ad libitum serum C-peptide immunoreactivity (CPR) of <0.3 ng/mL, and severe impairment of endogenous insulin secretion. Exclusion criteria were severe hepatic and/or renal impairment, severe infection, perioperative status, severe trauma, pregnancy or desire to become pregnant, ischemic heart disease (current or past), cancer, and other criteria by which the leading physician judges the patient as unsuitable. The study subjects underwent CGM by wearing a portable monitor. This study was approved by the Ethics Committee of Hyogo College of Medicine (No. 1425) and was registered in the University Hospitals Medical Information Network registry (No. 000010893).