Novo Nordisk's Levemir, which came out about five years after sanofi-aventis's Lantus, constitutes about twenty percent of the long-acting basal insulin sold worldwide. Lantus, the only other long-acting insulin analogue, makes up the other eighty percent.

The disparity may be due in part to the perception that Levemir should be used twice daily, while Lantus is used only once daily. In 2006, sanofieven filed a suit, later rejected, claiming that Novo was falsely promoting Levemir as effective for 24 hours.

But now Novo Nordisk is adding the slogan "24/7" to its ads about Levemir (detemir), saying that they have plenty of data to prove that it's a 24-hour insulin after all. According to their review of ten studies pitting Levemir against Lantus, nine of the studies found that both insulins lasted at least 24 hours in patients with type 2 diabetes and nearly 24 hours in patients with type 1.

For another opinion on whether long-acting insulins are really long-acting, see Dr. Bernstein's article, "There is No 24-Hour Basal Insulin."

Source: Bloomberg.com

Dr. Zachary Bloomgarden of Mount Sinai School of Medicine, prescribes Levemir to his patients.

His type 2 patients generally take one shot a day, but some take it twice. His type 1 patients always take it twice a day. He finds that Levemir is very similar to Lantus, but notes that there is some evidence of lesser glucose variability with Levemir. Most interesting to Dr. Bloomgarden is Levemir's possible weight benefit, although he emphasizes that there is neither extremely strong evidence of this nor any good clinical head-to-head study.

Allen King, MD, our advisory board member, prescribes Levemir to his diabetic patients.

Most of his type 2 patients use Levemir once a day. In low doses and in type 1 patients, either Levemir or Lantus is used twice a day.

Clinically, Dr. King sees no difference in duration of action between Lantus and Levemir. He notes, however, that the literature suggests that Levemir has less variability of action compared to Lantus (and therefore less hypoglycemia when achieving lower glucose targets), and possibly less weight gain associated with its use.

Also, Levemir is approved for 42 days after the first use of the vial or pen, while Lantus is approved for only 28 days - a difference that may be important to patients using small daily doses. Dr. King adds that both Levemir and Lantus are decided improvements over NPH.