Clinical presentation of insulin detemir

1
Clinical presentationof insulin detemir

• February 2006

2
Structure of insulin detemir
3
Insulin detemir mode of prolonging action

• Self association (hexameric)
• Fatty acid side chains bind to albumin in
  injection depot
• Albumin binding in circulation

Protracted absorption
Buffering effect and minor contribution to
protraction
4
PD profile of insulin detemir subjects with type
1 diabetes
Adapted from J. Plank et al. Diabetes Care
200528(5)1107-12
5
Less variable time-action profile than NPH
insulin or insulin glargine
Glucose infusion rate profiles following four
non-consecutive injections of identical doses
(0.4 U/kg, thigh) in three patients
Adapted from T. Heise et al. Diabetes 20041614-20
6
Consistent reduction in blood glucose
variability
7
Lower HbA1c than NPH in a meta-analysis of
clinical trials
Endpoint data from 6 trials comparing insulin
detemir with NPH insulin in basal-bolus therapy
in type 1 diabetes (Russell-Jones 2004,
Hermansen 2004, Home 2004, Pieber 2005) type 2
diabetes (Haak 2005, Raslova 2004)
A.J. Garber, H. Kim, E. Draeger. Diabetologia
200447(Suppl. 1)A58
8
Consistent improvement in balance between control
hypoglycaemia
Russell-Jones 2004
Overall hypoglycaemia
Nocturnal hypoglycaemia
9
Consistent reduction in weight gain
3
Levemir OADtreat-to-target study
Insulin detemir
2.5
plt0.05, insulin detemir vs. NPH insulin
NPH insulin
2












1.5
1
Weight change (kg)
0.5
0
Studies in type 2 diabetes
-0.5
Standl
Vague
Home
Haak
Home
Pieber
Pieber
Ralová
De Leeuw
Russell-Jones
-1
Hermansen
Hermansen
IDet (ampredinner) IDet (ambed) IDet (12
hourly) IDet (am bed)
10
Insulin detemir provides

• A prolonged and reproducible time-action profile
• Less variability in comparison to NPH insulin
• Improved glycaemic control compared with NPH
  insulin
• A risk reduction for nocturnal hypoglycaemia
  compared with NPH insulin
• Less weight gain