Lower within‐subject variability of fasting blood glucose and reduced weight gain with insulin detemir compared to NPH insulin in patients with type 2 diabetes

Haak, Thomas; Tiengo, Antonio; Draeger, Eberhard; Suntum, Mette; Waldhäusl, W.

doi:10.1111/j.1463-1326.2004.00373.x

Cited by 245 publications

(183 citation statements)

References 28 publications

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“…Initial bedtime basal insulin injection, sometimes combined with oral antidiabetic drugs, is among the most widely used regimens, but maintaining blood glucose control will then often need adaptations of insulin regimens toward MDI (38). The availability of short-and longacting insulin analogs in recent years does not alter this strategy, although a reduced incidence of hypoglycemia and a trend toward less weight increase have been reported in the use of long-acting analogs instead of NPH insulin for basal insulin coverage (39,40). Because of insulin resistance, a common feature of type 2 diabetes, large insulin doses are often needed to achieve tight blood glucose control, especially in very obese subjects and/or patients with liver steatosis (41).…”

Section: Csii and MDI In Type 2 Diabetesmentioning

confidence: 99%

Long-Acting Insulin Analogs Versus Insulin Pump Therapy for the Treatment of Type 1 and Type 2 Diabetes

Pickup

Renard

2008

Diabetes Care

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Insulin pump therapy (continuous subcutaneous insulin infusion [CSII]) is now an established form of intensive insulin treatment. It is pertinent to ask, however, if multiple daily injection (MDI) regimens based on new long-acting insulin analogs such as glargine and detemir have now replaced the need for CSII. In type 1 diabetes, CSII reduces the frequency of severe hypoglycemia compared with isophane-based MDIs, but the rate of severe hypoglycemia is usually similar on glargine-or detemir-based MDIs compared with isophane-based MDIs. CSII reduces A1C and glycemic variability compared with isophane-based MDIs; but glargine and detemir do not improve A1C or variability in many patients, particularly those who are prone to hypoglycemia. Head-to-head comparisons of CSII with MDI based on glargine indicate lower A1C, fructosamine, or glucose levels on CSII. It can be concluded that long-acting insulin analogs have not yet replaced the need for insulin pump therapy in type 1 diabetes, and CSII is the best current therapeutic option for some type 1 diabetic subjects. In type 2 diabetes, CSII and MDI produce similar glycemic control, although there is little study of MDI based on long-acting analogs compared with pumps. It is possible that CSII will be beneficial in selected patient groups with type 2 diabetes, but this requires further study. Diabetes Care 31 (Suppl. 2):S140-S145, 2008F or many decades, it has been accepted that poor glycemic control in insulin injection-treated diabetes is mainly due to the inadequacies of insulin pharmacology (1,2). Regular (shortacting) insulin is absorbed too slowly from the subcutaneous site to control postprandial hyperglycemia, and the delayed absorption then results in late hypoglycemia. Both of these problems have now been much improved by the introduction of more quickly absorbed monomeric insulins (3). The problems of longacting insulin formulations such as isophane and lente have taken longer to improve: they produce "hill-like" blood concentration and action profiles, resulting in a peak of over-insulinization in the middle of the night with a consequent risk of hypoglycemia, and a waning in insulinization before breakfast, resulting in fasting hyperglycemia (1,2,4). Moreover, these delayed-action insulin suspensions also have huge variability of subcutaneous absorption (1), contributing to much of the unpredictability in within-and between-day blood glucose control.The development of insulin pump therapy (continuous subcutaneous insulin infusion [CSII]) nearly 30 years ago (5) did much to overcome the problems of long-acting insulin injections. The constancy of the basal delivery allows for a near-flat blood insulin profile, adjustable at preset times to suit the changing needs of the patient throughout the day. The controlled delivery of small insulin amounts substantially reduces glycemic variability (6,7). For many years, these advantages have allowed a superiority of insulin pump therapy over insulin injection regimens, at least as far as the frequency of hypoglycem...

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Section: Csii and MDI In Type 2 Diabetesmentioning

confidence: 99%

Long-Acting Insulin Analogs Versus Insulin Pump Therapy for the Treatment of Type 1 and Type 2 Diabetes

Pickup

Renard

2008

Diabetes Care

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“…Many conventional antidiabetic agents, including thiazolidinediones (TZDs), insulin, sulphonylureas and meglitinides, are associated with weight gain; an exception is metformin, which has been associated with weight neutrality or modest weight reduction [39][40][41][42][43][44]. As further discussed below, the newer basal formulation insulin detemir exhibits limited weight gain in comparison to neutral protamine Hagedorn (NPH) insulin [45,46] and detemir, NPH insulin and insulin glargine have demonstrated modest weight reductions in combination with oral antidiabetic drugs (OADs) in a realworld setting [47]. Nevertheless, a vicious circle may ensue with antidiabetic agents, with increases in weight resulting in a secondary increase in insulin resistance, which subsequently necessitates an increase in medication requirements to maintain glucose homeostasis.…”

Section: Introductionmentioning

confidence: 99%

Diabesity: therapeutic options

Colagiuri¹

2010

Diabetes Obesity Metabolism

100

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A pathogenic relationship exists between type 2 diabetes and obesity. Over the last decade, the escalation in diabetes cases has paralleled the rapid increase in obesity rates, constituting a global health crisis. Environmental risk factors attributed to the global increase in obesity include the consumption of high-calorie, high-fat foods and inadequate physical activity. Obese individuals may also have a genetic predisposition for obesity. Both diabetes and obesity confer an elevated risk of developing a range of complications and comorbidities, including cardiovascular disease, hypertension and stroke, which can complicate disease management. This review examines the aetiology of the linkages between diabetes and obesity and the range of available therapies. Recent clinical evidence substantiating the efficacy and safety of incretin-based antidiabetic therapies is analysed, in addition to data on antiobesity therapeutic strategies, such as antiobesity agents, behaviour modification and bariatric surgery. Glucose control is often accompanied by weight-neutral or modest weight reduction effects with DPP-4 inhibitor treatment (sitagliptin, vildagliptin, saxagliptin) and weight loss with GLP-1 receptor agonist therapy (exenatide, liraglutide). Studies of antiobesity agents including orlistat, sibutramine and rimonabant have shown attrition rates of 30-40%, and the long-term effects of these agents remain unknown. Bariatric surgical procedures commonly performed are laparoscopic adjustable banding of the stomach and the Roux-en-Y gastric bypass, and have produced type 2 diabetes remission rates of up to 73%. Therapeutic strategies that integrate glycaemic control and weight loss will assume greater importance as the prevalence of diabetes and obesity increase. Keywords: DPP-4, exenatide, GLP-1 analogue, human, incretin, liraglutide, once-daily, type 2 diabetes mellitus Date submitted 2 June 2009; date of first decision 2 November 2009; date of final acceptance 4 November 2009 IntroductionThe term 'diabesity', coined by Sims and colleagues [1] in the 1970s, describes the strong link between type 2 diabetes and obesity [1,2]. As evidence of this pathogenic interrelationship continues to accumulate, so does the appearance of the term in the clinical literature. A large body of clinical evidence attests to the relationship between being overweight or obese and being at an elevated risk for development of type 2 diabetes [3][4][5][6][7]. The risk escalates with the degree of excess weight, increasing threefold with a body mass index (BMI) of 25.0-29.9 kg/m 2 and 20-fold with a BMI over 30 kg/m 2 [4]. In particular, abdominal fat accumulation exacerbates insulin resistance and confers a strong, independent risk of developing diabetes [8]. Global diabetes prevalence is estimated at 171 million and is projected to more than double, to 366 million, by 2030 [9]. Countries with the highest numbers of diabetes cases include India, China, USA, Indonesia and Japan [9][10][11]. The greatest relative increases in diabetes incide...

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“…This study has demonstrated that both insulin analogues (detemir once or twice-daily and glargine) had positive effect on glycemic fluctuation although it is not significant. Studies comparing the two insulin analogues with NPH insulin have shown that they are much better than NPH insulin regarding glycemic variability (12,13,15). However, the LANMET study using HbA1c and 8-point capillary glucose measurement as marker of glucose control has reported similar improvement with insulin glargine and NPH insulin added to the treatment of Type 2 diabetic patients who had not used insulin.…”

Section: Discussionmentioning

confidence: 90%

“…The pharmacodynamic and pharmacokinetic properties of the long-acting insulin analogues provide less nocturnal and overall hypoglycemia than do NPH and this benefit has been observed in several comparative clinical trials evaluating glycemic variability. Both long-acting analogues have shown lower within-subject variability in blood and plasma glucose measurements when compared with NPH (12,13). Insulin detemir demonstrated less within-subject variability of blood glucose levels than insulin glargine in patients with Type 1 diabetes (T1D) or T2D in headto-head comparisons of the analogues in glucose clamp studies (13,14).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Basal Analog Insulin on the Glycemic Variability in Type 2 Diabetics

Cander¹,

Gül²,

Dizdar³

et al. 2014

tjem

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Purpose:The aim of this study was to investigate the effect of insulin detemir and glargine on glycemic variability as determined by capillary blood glucose measurements in Type 2 diabetics treated with oral antidiabetic drugs. Material and Method: A total of 64 insulin-naive type 2 diabetics with a HbA1c level of 7.5%-10% were included in the study. The patients were randomized into 3 groups according to the basal insulin analog started; Group 1 (n=22) was started on once-daily detemir, Group 2 (n=22) twicedaily detemir, and Group 3 (n=20) insulin glargine. Basal insulin doses were titrated according to the morning/evening fasting capillary blood glucose levels. Standard deviations of the 8-point intraday fasting and postprandial blood glucose values were compared. Results: The fasting blood glucose intraday standard deviation values showed an improvement of 22.4% in Group 1, 21.4% in Group 2, and 26.4% in Group 3, while the intraday standard deviation for the postprandial values showed an improvement of 14.4%, 15.2%, and 38.7%, respectively (p>0.05). The standard deviation values did not show statistical significance when the groups were compared with each other. Baseline HbA1c values and insulin doses negatively correlated with the glycemic variability. Dicussion: Basal insulin added to treatment in Type 2 diabetics provided an improvement of 14.4% to 38.7% in glycemic variability. There was no significant difference between insulin glargine and detemir regarding this effect. Turk Jem 2014; 2: 33-38 Key words: Type 2 Diabetes, glycemic variability, basal insulin therapy Amaç: Bu çalışmanın amacı, oral antidiyabetik ilaçlar ile tedavi edilen Tip 2 diyabet hastalarında insülin detemir ve glarjinin, kapiller kan glukoz ölçümleri ile tespit edilen glisemik dalgalanmalar üzerine etkilerinin incelenmesidir. Gereç ve Yöntem: Daha önce hiç insulin kullanmamış ve HbA1c düzeyi %7,5-%10 arasında olan toplam 64 Tip 2 diyabetik hasta çalışmaya dahil edilmiştir. Hastalar başlanan bazal insulin analoguna göre 3 gruba randomize edildi; Grup 1'deki (n=22) hastalara günde tek doz insülin detemir, Grup 2'deki (n=22) hastalara günde iki doz detemir ve Grup 3'deki (n=20) hastalara insulin glarjin başlandı. Bazal insulin dozları sabah/ akşam açlık kapiller glukoz ölçüm düzeylerine göre titre edildi. Gün içi 8 nokta açlık ve öğün sonrası kan glukoz ölçümlerinin standart deviasyon değerleri karşılaştırıldı. Bulgular: Gün içi açlık kan glukoz ölçümlerinin gün içi standart sapma değerlerinde Grup 1'de %22,4, Grup 2'de %21,4 ve Grup 3'te %26,4 düzelme gözlenirken, öğün sonrası değerlerin standart sapma değerlerinde ise sırası ile %14,4, %15,2 ve %38,7 (p>0,05) düzelme tesbit edildi. Standart sapma değerleri her üç grup birebir karşılaştırıldığında istatistiksel olarak anlamlı fark tesbit edilmedi. Başlangıç HbA1c değerleri ve insulin dozları ile glisemik değişkenlik arasında negatif korelasyon tesbit edildi. Tartışma: Tip 2 diayebtiklerde tedaviye bazal insulin eklenmesi, glisemik dalgalanmalarda %14,4'ten %38,7'ye kadar iyileşme sağla...

show abstract

Lower within‐subject variability of fasting blood glucose and reduced weight gain with insulin detemir compared to NPH insulin in patients with type 2 diabetes

Cited by 245 publications

References 28 publications

Long-Acting Insulin Analogs Versus Insulin Pump Therapy for the Treatment of Type 1 and Type 2 Diabetes

Long-Acting Insulin Analogs Versus Insulin Pump Therapy for the Treatment of Type 1 and Type 2 Diabetes

Diabesity: therapeutic options

The Effect of Basal Analog Insulin on the Glycemic Variability in Type 2 Diabetics

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