Insulin detemir and insulin aspart: a promising basal-bolus regimen for type 2 diabetes

Rašlová, K; Bogoev, M.; I, Raz; Leth, G.; Ma, Guansheng; Hâncu, Nicolae

doi:10.1016/j.diabres.2004.03.003

Cited by 178 publications

(141 citation statements)

References 29 publications

Supporting

Mentioning

131

Contrasting

Unclassified

Order By: Relevance

“…The different pharmacokinetic properties of ASP-I in comparison to RH-I may add to the effects that insulin per se exerts on central nervous memory formation. In contrast to RH-I, that consists primarily of hexamers, ASP-I predominantly forms monomers so that after subcutaneous administration, it is more rapidly absorbed and lowers blood glucose more quickly than RH-I (Raslova et al, 2004;Hermansen et al, 2004). During intranasal administration, their reduced tendency to form hexamers may increase the number of ASP-I molecules transported from the nasal cavity to the brain and enhance insulin's effects on hippocampal memory processing.…”

Section: Discussionmentioning

confidence: 99%

Intranasal Insulin Improves Memory in Humans: Superiority of Insulin Aspart

Benedict

Hallschmid

Schmitz

et al. 2006

Neuropsychopharmacol

262

157

View full text Add to dashboard Cite

There is compelling evidence that intranasal administration of regular human insulin (RH-I) improves memory in humans. Owing to the reduced tendency of its molecules to form hexamers, the rapid-acting insulin analog insulin aspart (ASP-I) is more rapidly absorbed than RH-I after subcutaneous administration. Since after intranasal insulin administration, ASP-I may also be expected to access the brain, we examined whether intranasal ASP-I has stronger beneficial effects on declarative memory than RH-I in humans. Acute (40 IU) and longterm (4 Â 40 IU/day over 8 weeks) effects of intranasally administered ASP-I, RH-I, and placebo on declarative memory (word lists) were assessed in 36 healthy men in a between-subject design. Plasma insulin and glucose levels were not affected. After 8 weeks of treatment, however, word list recall was improved compared to placebo in both the ASP-I (po0.01) and the RH-I groups (po0.05). ASP-I-treated subjects performed even better than those of the RH-I-treated group (po0.05). Our results indicate that insulin-induced memory improvement can be enhanced by using ASP-I. This finding may be especially relevant for a potential clinical administration of intranasal insulin in the treatment of memory disorders like Alzheimer's disease.

show abstract

Section: Discussionmentioning

confidence: 99%

Intranasal Insulin Improves Memory in Humans: Superiority of Insulin Aspart

Benedict

Hallschmid

Schmitz

et al. 2006

Neuropsychopharmacol

262

157

View full text Add to dashboard Cite

show abstract

“…The weight-sparing effects of insulin detemir may be most pronounced in patients who are the most obese. 98,99 This weight-sparing phenomenon appears to be unique for insulin detemir. While some studies have shown that patients treated with insulin glargine initially gain less weight relative to those treated with NPH, 100,101 no difference between insulin glargine and NPH was noted in patients treated for 1 year.…”

Section: Weight Gainmentioning

confidence: 99%

Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence

Hartman

2008

Clinical Medicine & Research

115

View full text Add to dashboard Cite

Despi te 85 years of research since Banting and Best's isolation of insulin-containing extracts, 1 diabetes still remains one of the most significant causes of morbidity and mortality in the world, and its global impact is likely to accelerate over the coming decades. 2,3 Much of the medical and economic consequences of diabetes are attributable to its associated microvascular and macrovascular complications. [4][5][6] Two classic large-scale clinical studies, the Diabetes Control and Complications Trial (DCCT) 6 and the UK Prospective Diabetes Study (UKPDS), 7 demonstrated that intensive blood-glucose control policies can decrease the frequency of complications, arguing that physicians and patients should strive to mimic, as closely as possible, the serum levels of insulin produced by a healthy person. Secretion of insulin by the pancreas, however, is under complex regulation that depends on the intake of nutrients, other gastrointestinal peptides (e.g., incretins), and overall metabolic levels (i.e., exercise versus rest). 8 These physiological variables, which pose real challenges to the accurate metabolic replacement of insulin, are further complicated by the fact that diabetes requires self-management and therefore depends on the psychology, motivation, and understanding of the patient. A growing body of medical research has demonstrated that intensive control of serum glucose levels can minimize the development of diabetes-related complications. Success with insulin management ultimately depends on how closely a given regimen can mimic normal physiologic insulin release patterns.The new insulin analogs, including the rapid-acting analogs (aspart, lispro, glulisine), the long-acting basal analogs (glargine, detemir), and the premixed insulin analog formulations (75% neutral protamine lispro, 25% lispro; 50% neutral protamine lispro, 50% lispro; 70% protamine aspart, 30% aspart) have been formulated to allow for a closer replication of a normal insulin profile.The rapid-acting analogs can be administered at mealtimes and produce a rapid and short-lived insulin spike to address postprandial glucose elevations, while the long-acting analogs come close to the ideal of a smooth, relatively flat, 24-hour basal insulin supply, with less variability in action compared to NPH insulin. Despite these clear pharmacologic advantages, measurable clinical benefits in a complex disease such as diabetes can be hard to measure.To date, reviews of insulin analog studies have not found a dramatic overall improvement in glycosylated hemoglobin (HbA1c) outcomes compared to traditional human insulins, although all-analog basal-bolus regimens were associated with significantly lower HbA1c than all-human-insulin basal bolus regimens in some studies. Beyond HbA1c comparisons, however, insulin analogs have been shown in many instances to be associated with lower risks of hypoglycemia, lower levels of postprandial glucose excursions, better patient adherence, greater quality of life, and higher satisfaction with treatment.The long-act...

show abstract

“…14, [16][17][18][19][20][21][22][23][24] The differences, however, are relatively small in magnitude (<2 kg). The aim of this review was to conduct a literature search to compare studies involving individuals with T2DM, with or without prior insulin use, and the impact of glargine and detemir treatment on weight gain in relationship to reductions in A1c.…”

Section: Diabetes Technology and Therapeuticsmentioning

confidence: 99%

Relationship of Insulin Dose, A1c Lowering, and Weight in Type 2 Diabetes: Comparing Insulin Glargine and Insulin Detemir

Dailey

Admane

Mercier³

et al. 2010

Diabetes Technology & Therapeutics

View full text Add to dashboard Cite

Background: A pooled analysis of randomized controlled trials of individuals with type 2 diabetes mellitus (T2DM) was conducted to compare dosing and impact of two basal insulin analogs, insulin glargine (glargine) and insulin detemir (detemir), on weight and hemoglobin A1c (A1c). Methods: Twenty-two studies of at least 20 weeks in duration in individuals with T2DM initiating glargine/ detemir were included. Results were combined using a weighted-average method and a bivariate random effect model. Outcomes included changes in weight, A1c, and insulin dose from study start to end. Results: One study was head-to-head comparison of glargine and detemir. Detemir (four studies) was administered once or twice daily, with 50% starting on detemir once daily but needing therapy intensification. Glargine was used once daily in all 22 studies. The Egger test was borderline significant for change in weight over the course of the treatment for glargine (0.29; 90% confidence interval [CI] À0.01, 0.58), and heterogeneity was not observed for detemir (À0.18; 90% CI À0.59, 0.23). Heterogeneity was observed for change in A1c over the course of the treatment (glargine, À1.19, 90% CI À1.74, À0.63; detemir, À2.65, 90% CI À4.86, À0.45). Nonheterogeneity for change in A1c over the course of the treatment was achieved by excluding five studies for glargine and one study for detemir; however, all studies were included in subsequent analyses. In the unadjusted model, glargine and detemir showed similar results for mean A1c change (À1.4% vs. À1.4%), weight gain (2.5 vs. 1.7 kg), and weight/A1c (1.8 vs. 1.2 kg/%). A significantly higher detemir dose was needed to achieve the same A1c change (51.5 vs. 38.8 U/day). Conclusions: Although absolute weight gain was higher with glargine versus detemir, weight gain per A1c change was similar. A higher detemir dose was required to achieve a similar A1c reduction.

show abstract

Insulin detemir and insulin aspart: a promising basal-bolus regimen for type 2 diabetes

Cited by 178 publications

References 29 publications

Intranasal Insulin Improves Memory in Humans: Superiority of Insulin Aspart

Intranasal Insulin Improves Memory in Humans: Superiority of Insulin Aspart

Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence

Relationship of Insulin Dose, A1c Lowering, and Weight in Type 2 Diabetes: Comparing Insulin Glargine and Insulin Detemir

Contact Info

Product

Resources

About