Insulin Detemir Limits Weight Gain Associated With Insulin Therapy

New data, suggest that the novel long-acting insulin, insulin detemir (Novo Nordisk) can be used in people with type 2 diabetes without causing weight gain of the degree that typically accompanies this progression of therapy.

Furthermore, the more overweight a patient is before insulin therapy, the less weight they will tend to gain if insulin detemir, rather than conventional insulin, is chosen. This new finding is likely to be welcomed by both healthcare providers and patients concerned about the well-known side effect of weight gain with insulin therapy.

Professor Hermansen explained that while the initiation of insulin therapy improves blood glucose control, patients who gain weight considerably as a result of using insulin can undergo adverse changes in their blood pressure and lipid profiles1.

In the pivotal, large-scale ‘UKPDS’ study2 of type 2 diabetes, people beginning insulin therapy averaged a weight gain of nearly 5kg over the initial 3 years, and many gained considerably more than this.

"The prospect of gaining weight to this extent can often dissuade people with type 2 diabetes from accepting the need for insulin, or from adhering to their prescribed therapy," professor Hermansen says while adding: "Quite apart from their cosmetic concerns, these people risk incurring serious complications from their diabetes if they allow blood glucose to remain inadequately controlled as a result of delayed or insufficient insulin therapy."

More insulin detemir patients reached HbA1c < 7.0% without hypoglycemia in the 475 patient, 24-week trial over those on NPH insulin. Furthermore, significantly more recipients of insulin detemir achieved HbA1c levels of no more than 7.0% without any hypoglycemia (26% compared to 16% with NPH insulin, p = 0.008).
Although overall blood glucose control was similar in the two groups, there were marked differences in tolerability. People treated with insulin detemir benefited from a significantly lower incidence of episodes of hypoglycemia, with their overall and night-time risk being half that seen with NPH insulin (relative risk reductions, 47% and 55%, respectively, p <0.001, both endpoints).

People treated with NPH insulin gained an average 2.8kg in weight over 24 weeks, whereas those receiving insulin detemir gained just 1.2kg (p < 0.05). "When weight gain was assessed in terms of patients’ baseline body mass index (BMI), it became clear that overweight recipients of insulin detemir were benefiting from relatively greater reductions in weight gain" explained professor Hermansen. "In fact, the more overweight a person was at baseline, the less weight they would tend to gain, with clinically overweight and obese patients gaining little more than 0.5 kg. In contrast, patients treated with NPH insulin gained 2.5–3.0 kg regardless of their BMI."

In a Poster display by Dr. Katarina Raslova,(poster number 842) also showed less weight gain by baseline BMI in an analysis of data from 900 patients with type 2 diabetes when basal-bolus therapy was used

There was a tendency for weight gain to increase with baseline BMI in NPH insulin-treated patients, but this effect was not seen with insulin detemir. Among the most obese patients (BMI more than 35kg/m2) a slight weight loss (–0.45 kg) was associated with insulin detemir in contrast to an average gain of 2.4kg with NPH insulin.

In summary, all these new data suggest that: – Insulin detemir has a weight-sparing effect compared to conventional basal insulin when used either as the initial insulin therapy for type 2 diabetes (added to oral anti-diabetic drug therapy), or as the basal component of more intensified insulin-only therapy.
– This advantage is preserved even when the insulin dose is upwardly adjusted to the point where most patients achieve guideline target levels of blood glucose.
– The advantage is especially pronounced in patients who are already overweight or obese.
* Insulin detemir is a long-acting insulin analogue used as basal insulin, in combination with meal-related short- or rapid-acting insulin.
* Insulin detemir is indicated for treatment of diabetes mellitus for adults and children 6 years or older.

Presented at the European Association for the Study of Diabetes (EASD) Annual Meeting by Professor Kjeld Hermansen, Aarhus University Hospital, Denmark

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