Patients who take Levemir (insulin detemir) twice daily can chose a convenient evening time for their second dose. There appears to be little difference between dinner time and bedtime dosing, reported Eberhard Draeger, Ph.D., a director of clinical life-cycle management at Novo Nordisk, which makes Levemir.
“The time of evening administration of insulin detemir can be fitted to the needs and lifestyles of the individual patient in terms of [fasting plasma glucose] and nocturnal hypoglycemia,” said Dr. Draeger and colleagues in a poster presentation.
These results are what clinicians might have expected, said endocrinologist Larry Deeb, M.D., a clinical professor of pediatrics at the University of Florida in Tallahassee, and president-elect of the American Diabetes Association. He was not involved with the study.
“There’s really not a whole lot of difference between the two, certainly no clinical difference in the outcome,” said Dr. Deeb. “Is the evening better? No, and you wouldn’t expect it to be better. It’s probably easier for the patient.”
Nocturnal hypoglycemia occurred in at a rate of 9.1 events per patient year with evening dosing and 6.5 per patient year with bedtime Levemir dosing. So although the overall risk of hypoglycemia was not different between the groups, the relative risk of nocturnal events was 29% lower with bedtime dosing.
Dr. Deeb said it is a common practice to give this drug at morning and evening or morning and bedtime although the label initially said it should be given at bedtime.
“I think the important thing for clinicians is that we are discovering a great deal of flexibility in these long acting agents,” he said.
The study was a meta-analysis of two 16-week, open-label trials comparing NovoLog (insulin aspart) plus Levemir given in the morning and bedtime or in the morning and at dinner (or at a 12-hour interval), or NovoLog with a third arm of NPH insulin given at morning and bedtime.
Although dinner is at different times in different countries, the international cohorts averaged a dinnertime of about 7 p.m., while those who took Levemir at the 12-hour interval took the dose at about 8 p.m. on average.
The studies had a total of 773 patients with type 1 diabetes who were randomized evenly among the arms. After 12 weeks of treatment, the glucose control was similar between the two Levemir groups measured by HbA1c at approximately 7.6%.
Fasting plasma glucose levels were lower with those in the group who took Levemir at bedtime than in the evening (9.0 versus 9.8 mmol/L), which was a significant difference (P<0.001).
The real question was whether the daytime levels would be different because the patients who took Levemir at bedtime would have a longer day period between injections compared with those who took it in the evening, Draeger said.
The study found that the daytime self-measured blood glucose levels were comparable between the two regimens.
Practice Pearls: Explain to patients taking Levemir (insulin detemir) twice daily that this study suggests the second dose can be either at dinner time or at bedtime.
2006 American Diabetes Association Scientific Sessions- Pieber TR et al. “Time of Evening Administration of Insulin Detemir Can Be Fitted to Individual Needs and Lifestyle.”
DID YOU KNOW:
Study: Cystic Fibrosis Patients Battling a Unique Form of Diabetes
A growing number of cystic fibrosis patients are battling a second, often deadly complication: a unique form of diabetes that shares characteristics of the type 1 and type 2 versions that strike many Americans. Read and print the full news article at: http://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=3926