Insulin detemir (Levemir®) is a
long-acting insulin analogue indicated for use as basal
insulin therapy in patients with type 1 or 2
diabetes mellitus. The protracted action of
insulin detemir is explained by increased self-association and reversible binding to
albumin, which slows its systemic absorption from the injection site. In
glucose-clamp studies, less within-patient variability in
glucose-lowering effect was seen with
insulin detemir than with neutral
protamine Hagedorn (
NPH) insulin or
insulin glargine in patients with type 1 or 2 diabetes. The beneficial effect of
insulin detemir on glycaemic control was shown in numerous randomized, open-label, multicentre trials, including when used as basal-bolus
therapy in patients with type 1 or 2 diabetes and as basal
therapy in addition to oral
antidiabetic drugs in
insulin-naive patients with
type 2 diabetes. In terms of glycosylated haemoglobin (HbA(1c)).[primary endpoint in most trials],
insulin detemir was generally at least as effective as
NPH insulin,
insulin glargine or
insulin lispro protamine suspension in patients with type 1 or 2 diabetes, and at least as effective as
biphasic insulin aspart in patients with
type 2 diabetes. Less within-patient variability in
blood glucose was also generally seen with
insulin detemir than with
NPH insulin in patients with type 1 or 2 diabetes. Significantly less
weight gain was generally seen with
insulin detemir than with
NPH insulin in patients with
type 1 diabetes or with
insulin detemir than with
NPH insulin,
insulin glargine,
insulin lispro protamine suspension or
biphasic insulin aspart (in one study) in patients with
type 2 diabetes (i.e.
insulin detemir generally had a weight-sparing effect). The addition of
insulin detemir to
liraglutide plus
metformin improved glycaemic control in
insulin-naive patients with
type 2 diabetes and inadequate glycaemic control, although a significantly greater reduction in bodyweight was seen in patients receiving
liraglutide plus
metformin than in those receiving add-on
therapy with
insulin detemir. Results of two trials in patients aged 2-16 or 6-17 years (and a subgroup analysis in children aged 2-5 years) indicate that a basal-bolus
insulin regimen incorporating
insulin detemir appears to be a suitable option for use in paediatric patients with
type 1 diabetes. Less within-patient variation in self-measured fasting plasma
glucose was seen with
insulin detemir than with
NPH insulin in one of the studies.
Insulin detemir was noninferior to
NPH insulin in pregnant women with
type 1 diabetes in terms of the HbA(1c) value achieved at 36 gestational weeks. In addition, maternal and neonatal outcomes with
insulin detemir were similar to those seen with
NPH insulin. Subcutaneous
insulin detemir was generally well tolerated in the treatment of patients with type 1 or 2 diabetes, including in paediatric patients and pregnant women with
type 1 diabetes. The majority of adverse events, including serious adverse events, reported in
insulin detemir recipients were not considered to be related to the study drug.
Insulin detemir was generally associated with a significantly lower risk of nocturnal hypoglycaemia than
NPH insulin in patients with type 1 or 2 diabetes, particularly nocturnal minor hypoglycaemia. In conclusion,
insulin detemir is a useful option for use as basal
insulin therapy in patients with type 1 or 2 diabetes.