A lot of new diabetes medications have hit the market in recent years, demonstrating robust safety and efficacy profiles. These new treatment options offer new hope for patients; however, older antidiabetic therapies are being affected. Some of the older diabetes medications are being discontinued, with Levemir being one of them.

Levemir’s drug company announced in 2023 that it would discontinue Levemir in April of 2024. With the start of the new year, it will be harder and harder to get one’s hands on Levemir. This article will discuss the details of this discontinuation and how patients will be impacted.

How is insulin used in diabetes?

To understand the impact of the Levemir discontinuation, let’s first review the different types of diabetes and insulins. Type 1 diabetes is characterized by the body’s inability to create insulin, which in turn causes blood sugar dysregulation. In type 2 diabetes, the body does not make enough insulin or becomes insensitive to insulin, which also causes abnormal blood sugars. Over time, high blood sugar levels can lead to downstream complications of diabetes, affecting the heart, vision, nerves, hearing, and more.

Insulin is a major component of many people’s antidiabetic regimens. Insulin is naturally found within our bodies, functioning as a hormone that is produced by the pancreas. It works by removing blood glucose from the bloodstream so that the body can utilize it as energy.  By supplementing the body with insulin, diabetic patients can have more controlled blood sugar levels.

What types of insulin are available?

There are several different types of insulin, including:

  • Rapid-acting insulin
  • Short-acting insulin
  • Intermediate-acting insulin
  • Mixed insulin
  • Long-acting insulin

These types of insulin differ concerning how quickly they decrease blood sugar when they reach their maximum strength, and how long they work for. Depending on your diabetic regimen, you may be on a few different types of insulin to manage your blood sugar. A regimen is selected based on someone’s food habits, activity levels, current blood sugar parameters, age, and type of diabetes.

Rapid and short-acting insulin provides blood sugar control in response to food at mealtime. Intermediate and long-acting insulin helps to provide general glycemic control throughout the day. Our insulin of interest, Levemir, is a form of long-acting insulin. It provides prolonged, gradual insulin release, lasting up to 18 hours. Long-acting insulin has an onset of two hours, and the concentrations do not peak. It is usually used together with a rapid- or short-acting insulin for complete blood sugar control.

Levemir is the brand name of a medication known as insulin detemir. Insulin detemir is indicated for the treatment of both types of diabetes, including type 1 and type 2 diabetes. It was originally approved by the Food and Drug Administration (FDA) in 2005.

How is Levemir provided?

Levemir was approved in a few dosage forms, initially as a 10 mL multidose vial and a prefilled pen referred to as Levemir FlexPen. Subsequently in 2014, the company discontinued Levemir FlexPen and replaced it with Levemir FlexTouch, another insulin delivery pen.

As aforementioned, Levemir is a long-acting form of insulin, that supports blood sugar management over the entire course of the day. The Levemir FlexTouch prefilled pen has 300 U of insulin detemir and can provide doses between 1 and 80 U.

What led up to the Levemir discontinuation?

As of January 2024, Novo Nordisk cut the cost of numerous insulin products by as much as 75 percent. These drugs include insulin products such as vials and pre-filled pens of long-acting, short-acting, and pre-mix insulins. In particular, Novolin, Novolog Mix 70/30, Novolin, and Levemir are affected. Levemir’s price specifically was decreased by 65 percent, with the new prices being the following:

  • Vial: $107.85
  • Flexpen: $161.77

According to the manufacturer, the purpose of these price cuts was to minimize the financial burden associated with insulin therapy for patients. While this certainly has and will be the case, it will unfortunately be short-lived for these patients. Levemir will be discontinued permanently by Novo Nordisk by 2025.

Why is Levemir being discontinued?

Levemir is being discontinued by its manufacturer Novo Nordisk. The company announced the following with regards to anticipated dates:

  • January 2024: Levemir FlexPen experiences supply disruptions
  • April 2024: Discontinuation of Levemir Flexpen
  • December 2024: Complete discontinuation of Levemir, including the Levemir vial

It is important to note that the discontinuation of Levemir is not due to poor efficacy or safety concerns. It has been fairly commonplace to discontinue certain insulin types over the past several decades. As many as 62 insulin types have been discontinued since the discovery of insulin. Oftentimes this is the result of high costs and the development of more advanced delivery methods and formulations.

There are several reasons for Levemir’s discontinuation, including, manufacturing issues, formulary loss, and alternative options. With regards to alternative options, newer and more enhanced insulin therapeutic options are available on the market. This includes Novo Nordisk’s other long-acting insulin product Tresiba (insulin degludec), which provides less frequent dosing and lower side effects like hypoglycemia.

The market has also shifted its course a bit to focus on glucagon-like peptide-1 (GLP-1) receptor agonist drugs. This medication class is incredibly profitable, boasting efficacy in the realms of both diabetes and weight loss. Novo Nordisk itself manufactures semaglutide, known as both Wegovy and Ozempic, which has gained immense popularity in recent years.

How does this discontinuation impact patients?

While there are several other options to replace Levemir on the market, many patients are concerned about the discontinuation. Some patients have been stabilized on the medication since the early days of its approval in the 2000s. It has several benefits, including the opportunity for dose adjustments because it is quickly metabolized.

Patients currently on Levemir will need to discuss with their physician to switch their long-acting insulin therapy. That means saying goodbye to the newfound affordability of Levemir, as it will soon be phased out. The good news is that there are a lot of other options available on the market for long-acting insulins.

What other options do I have?

Although patients already stabilized on Levemir may be worried or disappointed, other types of long-acting insulin are available. These include insulin glargine and insulin degludec. The details of these insulins are outlined below:

  • Insulin glargine. Insulin glargine is sold under several different brand names, including Lantus, Toujeo, Abasaglar, Suliqua, and Semglee. It is provided in several formulations, including pre-filled pens, cartridges, and vials. Additionally, Suliqua combines both insulin glargine and lixisenatide.
  • Insulin degludec. We touched on insulin degludec, which is sold under the brand name Tresiba, earlier in this article. Also manufactured by Novo Nordisk, Tresiba is available as pre-filled pens, cartridges, and prefilled pens combined with liraglutide.

How can I make the switch?

If you are on Levemir, and your provider has not already discussed the discontinuation with you, it would be a good idea to make an appointment. Your healthcare provider will be able to assess your insulin requirements with Levemir and switch you to an alternative option, such as one of the other long-acting insulins above.

It is best to avoid delaying this office visit, as it will likely be more difficult to access Levemir as the year goes on. For example, the Levemir FlexPen will be discontinued as early as April. If you do not switch soon, you may find yourself unable to access the medication and thus not able to manage your blood sugar levels. Recall the dangerous effects of uncontrolled blood sugars over prolonged periods.

Conclusion

In summary, factors like manufacturing issues, pricing, and newer drugs have led to the displacement of Levemir from the diabetes market. Although patients stabilized on Levemir have concerns, there are other alternative long-acting forms of insulin on the market. Thus, patients on Levemir should discuss with their doctor their options for switching therapy. This should be done sooner rather than later so that you can ensure that you are stabilized on a long-acting insulin to manage your blood sugars.