Definitions

reduced hemoglobin

Insulin detemir

Insulin detemir is a long-acting human insulin analogue for maintaining the basal level of insulin. Novo Nordisk markets it under the trade name Levemir. It is an insulin analogue in which to the lysine amino acid at position B29 a fatty acid (myristic acid) is bound. It is quickly resorbed after which in the blood it binds to albumin through the fat acid at position B29. It then slowly dissociates from this complex.

In a clinical study (see ref 2) which compared the efficacy and safety of using Levemir for the treatment of patients with type 2 diabetes who had suboptimal glycemic control while receiving maximally tolerated doses of metformin and sulfonylurea (common tablet therapies for type 2 diabetes), it was found that, "At 24 weeks, A1C (glycosylated hemoglobin) had decreased by 1.8 and 1.9% (from 8.6 to 6.8 and from 8.5 to 6.6%) for detemir and NPH, respectively (NS). In both groups, 70% of participants achieved an A1C of 7.0%, but the proportion achieving this without hypoglycemia was higher with insulin detemir than with NPH insulin (26 vs. 16%, P = 0.008). Compared with NPH insulin, the risk for all hypoglycemia with insulin detemir was reduced by 47% (P < 0.001) and nocturnal hypoglycemia by 55% (P < 0.001). Mean weight gain was 1.2 kg with insulin detemir and 2.8 kg with NPH insulin (P < 0.001), and the difference in baseline-adjusted final weight was –1.58 (P < 0.001)."

In short, it was found that insulin detemir reduced Hemoglobin A1C to target levels of 7.0% for 70% of patients, similar to human basal insulin NPH, but without the same risk of hypoglycemia (low blood sugar) and with much lower weight gain.

Similar results have been seen in type 1 diabetes (see ref 3.)

References

1. http://content.nejm.org/cgi/content/full/NEJMoa075392, Addition of Biphasic, Prandial, or Basal Insulin to Oral Therapy in Type 2 Diabetes; Rury R. Holman, M.B., Ch.B., F.R.C.P., Kerensa I. Thorne, M.Sc., Andrew J. Farmer, D.M., F.R.C.G.P., Melanie J. Davies, M.D., F.R.C.P., Joanne F. Keenan, B.A., Sanjoy Paul, Ph.D., Jonathan C. Levy, M.D., F.R.C.P., for the 4-T Study Group

2. http://care.diabetesjournals.org/cgi/content/abstract/29/6/1269?ijkey=2e8d412f27ded6ae0a205b3bfd4d3608ed9b64b5&keytype2=tf_ipsecsha , A 26-Week, Randomized, Parallel, Treat-to-Target Trial Comparing Insulin Detemir With NPH Insulin as Add-On Therapy to Oral Glucose-Lowering Drugs in Insulin-Naïve People With Type 2 Diabetes, Kjeld Hermansen, MD1, Melanie Davies, MD2, Taudeusz Derezinski, MD3, Gabrielle Martinez Ravn4, Per Clauson4, Philip Home, DM, DPHIL5 on behalf of the Levemir Treat-to-Target Study Group

3. http://www.springerlink.com/content/6lktug1r2exurq0j/?p=af5e2f613a0f4c6690f8fdc920f48bd6&pi=5 , Insulin analogues (insulin detemir and insulin aspart) versus traditional human insulins (NPH insulin and regular human insulin) in basal-bolus therapy for patients with Type 1 diabetes, Journal Diabetologia, Issue Volume 47, Number 4 / April, 2004.

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