Less Weight Gain With Insulin Detemir

Insulin detemir achieved target HbA1c values with less hypoglycaemia and weight gain than NPH insulin. A group of investigators led by Dr Kjeld Hermansen of the Aarhus University Hospital in Aarhus, Denmark, compared the efficacy and tolerability of insulin detemir with that of NPH insulin when added to oral therapy for type 2 diabetes. A total of 476 patients with HbA1c 7.5-10.0% were randomized to twice-daily insulin detemir or NPH insulin for 24 weeks. Doses were titrated to target preprandial plasma glucoses concentrations of 6.0mmol/L or less using a forced titration algorithm .

The investigators found that HbA1c was reduced to a similar degree in both treatment groups. More patients in the insulin detemir group achieved a target HbA1c of 7.0% or less without hypoglycaemia, compared with those in the NPH insulin group (26% vs 16%; p= 0.008). Insulin detemirreduced the risk of hypoglycaemia by 47% (p<0.001) and the risk of nocturnal hypoglycaemia by 55% (p<0.001), compared with NPH insulin. Patients in the insulin detemir group gained 1.6 kg less than patients on NPH (1.2kg vs 2.8kg; p<0.001).

The investigators concluded that, for patients with type 2 diabetes inadequately controlled with oral therapy, the addition of basal insulin with aggressive titration improved glycaemic control, and that insulin detemir achieved target HbA1c values with less hypoglycaemia and weight gain than NPH insulin.

Diabetes Care 2006;29:1269-74