Call It Predictable

Insulin detemir, the long-acting insulin analog from Novo Nordisk, has a more predictable blood glucose-lowering effect than both long-acting insulin glargine (Lantus) and NPH.

In a German study funded by detemir maker Novo Nordisk, 54 adults with type 1 diabetes (32 males and 22 females) received four single doses calculated based on body weight of either detemir, Lantus or human NPH insulin on four identical study days in a clinical research center.

Detemir was associated with significantly less withinsubject variability than both NPH insulin and Lantus.

Novo Nordisk has applied for FDA approval for insulin detemir.

—Diabetes, June 2004

Tim Heise, MD, was a lead researcher for the detemir study:

What is blood glucose predictability, and why is it important to people with diabetes?

Blood glucose predictability may be translated as reliability of blood glucose responses. If a person with diabetes injects the same amount of insulin in the morning on two different days at comparable fasting blood glucose concentrations, they expect their blood glucose concentrations over the day to behave similarly. Unfortunately, as every patient knows, this often is not the case. Although all conditions like carbohydrate intake, exercise, etc., are similar, there might be major differences in the blood glucose responses to a given dose of insulin. This obviously is a major obstacle to obtaining good diabetes control and safety.

When you say that insulin detemir was associated with “significantly less within subject variability than both NPH insulin and [Lantus],” what does that mean?

This means that the blood glucose responses to a given dose of insulin detemir are more predictable than those to NPH insulin or Lantus. It is more reliable in this sense:

When an insulin’s action is not reliable, it means that the same dose of insulin will lead to different blood glucose responses. Sometimes the effect may be higher, sometimes lower.

This makes it very difficult to get good blood glucose control, because patients cannot rely on the insulin always exhibiting the same effect. This, of course, could really put the subject at risk of getting low blood glucose values. This risk is 0.1 percent if the subject uses insulin detemir, 2.7 percent if the subject uses insulin glargine and 6.5 percent with NPH insulin. In other words, when the subject uses their basal insulin twice a day over a period of 1,000 days, they will get more than twice the usual maximum effect at four days with insulin detemir, at 54 days with insulin glargine and at 130 days with NPH insulin.

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