Insulin treated diabetic patients have often to contend with variability in the action of injected
insulin and to some unpredictibility in
glycemic control. The variability in
blood glucose control seems particularly important with long-acting
insulins.
Insulin detemir belongs to a new class of non-crystalline form of
long-acting insulin analogs. Absorption of
insulin detemir is dependent on neither appropriate resuspension before injection and dissolution of crystals in the subcutaneous tissue, as is the case for
NPH insulin, nor on formation and dissolution of microprecipitates, as is the case for
insulin glargine. In euglycemic
glucose clamp studies,
insulin detemir was associated with significantly less within-subjects variability for the pharmacodynamic endpoints than both
NPH insulin and
insulin glargine. Three, up to 6 months trials, carried out in patients with
type 1 diabetes have shown that the day-to-day within-subject variations in plasma
glucose were significantly lower with
insulin detemir than with
human NPH insulin. Similar results have been reported in patients with
type 2 diabetes. Nightly 8-h plasma
glucose recordings showed a smoother and more stable profile with
insulin detemir than with
NPH insulin. In patients with
type 1 diabetes the combination of
insulin detemir with mealtime
insulin aspart, a fast-acting
insulin analog, provides a smoother and more stable profile with lower post-prandial plasma
glucose levels that the combination of
NPH insulin with regular human
insulin before each meal. In several trials, the risk of
hypoglycemia, particularly of nocturnal
hypoglycemia, was significantly lower with
insulin detemir than with
NPH insulin. In conclusion
insulin detemir offers a better reproducibility as compared with other basal
insulins, reduces the risk of
hypoglycemia, and may lead the patients to titrate their
insulin doses more easily and therefore to achieve more often glycemic objectives. The combination of rapid- and
long-acting insulin analogs reproduces a more physiological insulin secretion and thereby reduces the risk of
hypoglycemia and improves the overall 24-h glycemic profile.