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The long-acting modern insulin Levemir® (insulin detemir) improves blood
glucose control, reduces weight and the risk of overall hypoglycemia when started
once daily in people with type 2 diabetes, according to new data[1] presented
at the 19th world congress of the International Diabetes Federation (IDF) in
Capetown, South Africa.
The new data, a sub-analysis from a large, multinational study called PREDICTIVE™,
are important because many people with type 2 diabetes gain weight when they
start on other, conventional types of insulin therapy, further increasing their
already high risk of cardiovascular disease.[2]
“Many people with type 2 diabetes are overweight or obese to begin with,
and starting insulin therapy often leads to even more weight gain,” said
lead investigator Dr Anne Dornhorst. “Our findings showed that not only
did Levemir® once daily improve glycemic control, but unlike many other
forms of insulin, it actually led to weight loss and this benefit was even greater
for the heaviest patients.”
PREDICTIVE™ (Predictable Results and Experience in Diabetes through
Intensification and Control to Target: An International Variability Evaluation)
is a multinational, open-label, prospective, observational study to evaluate
the safety and efficacy of Levemir® in people with type 1 and type 2 diabetes
from more than 20 countries. The new data presented at IDF were from a 14-week
analysis of a European subgroup of 2,377 individuals with type 2 diabetes who
were being treated with OADs and had not previously used insulin therapy. Upon
entering the study, these patients started taking Levemir®, dosed with or
without their previous OADs, based on their physician’s clinical judgement.
Most patients (82%) used Levemir® once daily.
The results indicate that after 14 weeks, the individuals taking Levemir®
lost 0.7 kg of body weight (1.5 lbs) compared to baseline (p<0.001). The
weight loss was more pronounced in those who entered the trial at higher weight.
For example, those who had a body mass index (BMI, a measure of weight for height)
between 27 and 29, which is considered overweight, lost an average of 0.56 kg
(1.2 lbs), whereas those with a BMI at 31 or higher (considered obese) lost
1.51 kg (3.3 lbs). These reductions in weight were significant (p<0.0001)
compared to baseline. As expected, Levemir® improved glycemic control over
the 14 weeks. The average level of HbA1c, an indicator of long-term glycemic
control, decreased from 8.9% to 7.6% – over a period of three months.
All these improvements in glycemic control were significant (p<0.0001).
Hypoglycemia (low blood sugar) is also a concern in people with diabetes,
and the risk of hypoglycemia can be increased with insulin therapy. However,
the study showed that the incidence of hypoglycemic episodes four weeks after
starting Levemir® was actually less than it was four weeks before the study:
1.2 vs 1.4, 0 vs 0.1 and 0.3 vs 0.4 episodes/patient-year for total, major and
night-time hypoglycemic episodes, respectively. The decrease in major episodes
was statistically significant (p<0.001).
[1] Dornhorst A, Hernandez FO, Koenen C, Lüddeke H-J;. Poster presentation
at: 19th world congress of the International Diabetes Federation, Capetown,
South Africa, December 3-7, 2006. [2] Ridderstrale M, Gudbjornsdottir S, Eliasson
B, Nilsson PM, Cederholm J, Steering Committee of the Swedish National Diabetes
Register (NDR). Obesity and cardiovascular risk factors in type 2 diabetes:
results from the Swedish National Diabetes Register. J Intern Med 2006; 259(3):
314–322.
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