Can a cost comparison be made available between Glargine and Detemir to understand the cost of treatment with both the drugs

- Chandrakant Kathote

As recently pointed out in a review of clamp studies by Heise et al (Diabetes, Obesity & Metabolism, 2007), the Porcellati group is the only group to have been able to demonstrate a protracted duration of action for insulin detemir. Three other studies have demonstrated 24-hour duration of action of insulin detemir in patients with type 1 and type 2 diabetes. These studies also show significantly less within-subject variability, thereby reducing the risk of hypoglycaemia and allowing clinicians and patients to more effectively titrate insulin dose.

As a CDE, I've seen both of these insulins last 24 hrs and "poop out" within 24 hrs. I believe there are individual differences in how the body uses meds. Another reason why someone with diabetes has to be treated individually.

As a user of both of these insulins, Lantus peaks 6-10 hours after injection and has never lasted 24 hours. Detemir lasts almost 24 hours with a much smoother action and less of a peak. Lantus always has required 2 doses a day for me to work. (12-14 units basal per24 hours)

I have used both Lantus and Detemir as my Basal Insulin.
With Detemir I find that I have to take almost 35% more insulin compared to Lantus for blood glucose consistency.
In addition, I found that I had experienced more episodes of Hypoglycemia with Lantus than Detemir and both required a 2Xday injections as well.
Itching continues to occur at the site injection with Detemir while none had occurred using Lantus.

I have also used both Lantus and Detemir as my Basal Insulin. Detemir did not last nearly as long. I had to take it every 8 hours (3X/day), and it had a more pronounced peak. I returned to Lantus, taking it twice a day, at 11 units each shot. Lantus works best for me.

Levemir works very well when metformin is introduced into therapy. FBS are now

lantus is more effective than detemir.. It is backed up by several studies wherein it is used once daily.

No one need look any further than the product package inserts. Levemir is dose dependent, lasting as little as 5.7 hours at a dose of 0.1 units per kilogram vs. 23.2 hours at a dose of 1.6 units per kilogram. Do the math. For Levemir to last a full 24 hours, a 220 pound man would have to take in excess of 160 units per day. And by looking at the PK/PD profile of insulin detemir, the higher the dose, the higher the peak action, even greater than the accepted peak of NPH. The "Medical Letter" even concludes that Levemir is a BID medication, and more recent studies have shown that more Levemir is required to achieve the same glucose lowering effect as either NPH or Glargine. I'm still confused as to why some individuals see an advantage to taking an intermediate acting insulin like Detemir to a long acting insulin like Glargine.

Is .35 units per kilo a standard dose? I thought patients took much more than that.

Every study done by Sanofi-Aventis is done at a single dose level which is a typical dose range of 0.4U/kg. Their so-called peakless profile has never been reproduced in any other study than the Lepore study. If they were to actually do a study with 0.1 or 0.2U/kg they would also find that they do not last 24 hours but much less. Their PI indicates that they were not even successful at controlling the A1c as good as NPH. The variability of intrasubject sugar control is double that of Levemir leading to weight gain, greater hypoglycemia. It is simple pharmacodynamics that all medicines have a rise to a peak and a fall which makes them dose dependent. Somehow people think that Lantus goes directly to a peak level and stays there until the magical time of 24 hours and then it all completely disappears. This is simply inaccurate and misleading. The conclusion that one would require 160 units per day is completely false. The advantage to an additional 24 hour basal such as Levemir vs Lantus is more consistent sugar control, less hypoglycemia, and low to no weight gain.

I am confused. It says in the lantus p.i. that, "The median time between injection and the end of pharmacological effect was 14.5 hours (range: 9.5 to 19.3 hours) for NPH human insulin, and 24 hours (range: 10.8 to >24.0 hours) (24 hours was the end of the observation period) for insulin glargine." Does this mean that Lantus can only last 10 hours at a low dose like NPH and have to be taken twice a day?