A 24-Week, Randomized, Treat-to-Target Trial Comparing Initiation of Insulin Glargine Once-Daily With Insulin Detemir Twice-Daily in Patients With Type 2 Diabetes Inadequately Controlled on Oral Glucose-Lowering Drugs

Abstract

OBJECTIVETo determine whether glargine is noninferior to detemir regarding the percentage of patients reaching A1C <7% without symptomatic hypoglycemia ≤3.1 mmol/l.RESEARCH DESIGN AND METHODSIn this 24-week trial, 973 insulin-naive type 2 diabetic patients on stable oral glucose-lowering drugs with A1C 7.0–10.5% were randomized to glargine once daily or detemir twice daily. Insulin doses were systematically titrated.RESULTS27.5 and 25.6% of patients reached the primary outcome with glargine and detemir, respectively, demonstrating the noninferiority of glargine. Improvements in A1C were −1.46 ± 1.09% for glargine and −1.54 ± 1.11% for detemir (P = 0.149), with similar proportions of patients achieving A1C <7% (P = 0.254) but more detemir-treated patients reaching A1C <6.5% (P = 0.017). Hypoglycemia risk was similar. Weight gain was higher for glargine (difference: 0.77 kg, P < 0.001). Glargine doses were lower than detemir doses: 43.5 ± 29.0 vs. 76.5 ± 50.5 units/day (P < 0.001).CONCLUSIONSIn insulin-naive type 2 diabetic patients, glargine reached similar control as detemir, with more weight gain, but required significantly lower doses.

Iowa medicaid 2: lapse of glycemic control on abrupt transition from insulin glargine to insulin detemir in type 2 diabetes mellitus

“…This finding is consistent with observations in another study in which a substantial reduction in daily dose of insulin glargine was noted with a transition from insulin detemir in subjects with type 2 Diabetes [9]. Several other studies have also documented a requirement of a higher daily dose of insulin detemir in comparison to insulin glargine to attain comparable glycemic control [10][11][12][13][14][15][16][17][18][19]. Thus, a higher daily dose and twice daily administration of insulin detemir may have been required to achieve desirable glycemic goal in this study as documented in previous studies in most subjects with both Type 1 and Type 2 diabetes [1,[10][11][12][13][14][15][16][17][18][19].…”

“…Several other studies have also documented a requirement of a higher daily dose of insulin detemir in comparison to insulin glargine to attain comparable glycemic control [10][11][12][13][14][15][16][17][18][19]. Thus, a higher daily dose and twice daily administration of insulin detemir may have been required to achieve desirable glycemic goal in this study as documented in previous studies in most subjects with both Type 1 and Type 2 diabetes [1,[10][11][12][13][14][15][16][17][18][19]. The requirement for a higher daily dose for insulin detemir in comparison to insulin glargine in order to achieve identical glycemic control in type 2 Diabetes is further confirmed in a recent study examining pharmacokinetics and pharmacodynamics of these insulins [20].…”

“…], needed for twice daily administration in most subjects due to increased number of injections; higher daily insulin dose as well at least twice daily monitoring of blood glucose as documented in several recent studies [16,27,28]. Switching from insulin glargine to insulin detemir is also likely to increase costs because of consequences induced by a lapse of glycemic control [29].…”

Clinical value of glargine 300 U/mL based on randomized trials and routine medical practice

“…doses of insulin detemir higher by an average of 35% are required to achieve similar control of diabetes versus glargine) [19][20][21]. Differences between results of randomized clinical trials and routine clinical practice were also demonstrated in this case.…”

Insulin Detemir Use Is Associated With Higher Occurrence of Hypoglycemia in Hospitalized Patients With Hypoalbuminemia

“…There are no human studies on pharmacokinetics or outcomes of using detemir in hypoalbuminemic patients. Randomized controlled studies of detemir versus glargine have not found a difference in hypoglycemia (6)(7)(8)(9), but these trials included only a few hundred patients who probably were not hypoalbuminemic. A recent retrospective study found a higher rate of hypoglycemia (,70 mg/dL) in determir-treated compared to glargine-treated inpatients (10).…”