Detemir vs Glargine: Comparison of Inpatient Glycemic Control

Abstract

Context Hyperglycemia in the hospital setting is associated with increased morbidity and mortality. In an attempt to cut costs, some hospitals implement policies to substitute all glargine orders with detemir. Objective To examine how the substitution of glargine with detemir affects inpatient blood glucose control. Methods Medical records were retrospectively analyzed to investigate the effect of a hospital formulary change at a semi-urban underserved hospital that substituted detemir for glargine on a 1:1 dosing basis. The study evaluated blood glucose control from September 6, 2015, to September 5, 2016, before substitution and from September 6, 2016, to September 5, 2017, after the substitution began. Patients were included in the study if they were older than 18 years, received glargine before admission, and had type 1 or 2 diabetes mellitus. Patients were excluded if they were pregnant, did not receive long-acting insulin, or lacked regular blood glucose testing. The medical records were analyzed for mean glucose levels, hypoglycemic events, and short-acting insulin administration amounts. Results A total of 318 patients met criteria and were included in the retrospective analysis—134 patients received detemir and 184 patients received glargine. The mean glucose levels in the morning were 133.8 mg/dL for patients receiving detemir and 145.8 mg/dL for patients receiving glargine (95% CI, 126.972-140.753; P=.013). The mean blood glucose levels in the afternoon were 171.6 mg/dL for patients receiving detemir and 172.1 mg/dL for patients receiving glargine (95% CI, 162.955-180.344; P=.938). The mean blood glucose levels in the evening were 162.5 mg/dL for patients receiving detemir and 163.3 mg/dL for patients receiving glargine (95% CI, 153.654-171.315; P=.897). The mean blood glucose levels at night were 176.1 mg/dL for patients receiving detemir and 174.7 mg/dL for patients receiving glargine (95% CI, 167.797-184.474; P=.788). No significant difference in sliding scale insulin was required between the patient groups (0.16 U/kg insulin aspart in detemir group vs 0.18 U/kg aspart in glargine; 95% CI, 0.154-0.189; P=.297). There was no significant difference between the patient groups in regard to hypoglycemic events (45% glargine vs 49% detemir; P=.59). Conclusion Substituting detemir for glargine did not adversely affect inpatients’ blood glucose control.

Rate of Inpatient Hypoglycemia Following a 1:1 Dose Interchange Between Concentrated Insulin Glargine to Insulin Detemir

“…The hypoglycemic event rate seen in the iGlar100 arm in our study (19.3%) was lower than the event rates seen in a similar analysis conducted by Capson, et al evaluating the 1:1 conversion from iGlar100 to iDet100 or maintained on iGlar100 in an inpatient setting (46% and 49%). 17 However, our study did not intend on capturing the totality of hypoglycemic events during an inpatient admission and excluded any hypoglycemic events occurring before insulin administration, after a dose change inpatient, or any that occurred after the first hypoglycemic event. While this likely resulted in a comparatively lower overall hypoglycemic event rate recorded, both studies align in support that a 1:1 conversion between iGlar100 to iDet100 in the inpatient setting is likely appropriate.…”

“…16 Discrepancies in insulin potency also exist between nonconcentrated insulins; however, a 1:1 unit conversion when switching between iGlar100 and iDet100 does not appear to have a significant impact on rates of hypoglycemia. 4,17 Transitioning concentrated insulin to a non-concentrated basal insulin may further expose known variations in insulin unit potency and PK/PD differences and potentially contribute to undesired outcomes. 18,19 Clinical opinion suggests that dose reductions may be appropriate when transitioning from outpatient concentrated insulins to formulary agents.…”

Retrospective trial of long acting analogues detemir and degludec usage in children and adolescents to overcome glucose variability caused by dawn phenomenon and reverse dawn phenomenon

“…В одном из исследований при переводе с гларгина на детемир взрослых с СД1 и СД2 были выявлены преимущества детемира в виде уменьшения числа гипогликемий [20], в другом исследовании в период пребывания в стационаре у аналогичной группы пациентов, применявших детемир, наоборот, отмечалась большая частота гипогликемий, чем на гларгине [21]. В двух ретроспективных и двух проспективных исследованиях взрослых, использовавших детемир и гларгин, различий не было выявлено [22][23][24][25].…”