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Detemir as a once-daily basal insulin in type 2 diabetes.
MedLine Citation:
PMID:  22287854     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Insulin detemir, a long-acting basal insulin analog, is labeled for once-daily or twice-daily dosing in patients with type 1 (T1DM) or type 2 (T2DM) diabetes mellitus. Protocols for some earlier clinical studies of detemir evaluated twice-daily dosing, which may have generated the misperception that detemir should be prescribed twice daily for most patients. This review examines pharmacokinetic and pharmacodynamic (PK/PD), observational, and controlled studies that have evaluated once-daily and twice-daily detemir in patients with T2DM to determine the efficacy and safety of once-daily dosing.
METHODS: PubMed was searched using the keywords "detemir," "once daily," "twice daily," and "type 2 diabetes" with the limits of clinical trial, human, and English.
RESULTS: Detemir has a relatively flat time-action profile and duration of action of up to 24 hours for patients with T2DM. Once-daily dosing is the most commonly used detemir regimen reported in observational studies, and controlled clinical studies indicate that once-daily dosing controls glycosylated hemoglobin when detemir is administered alone or in combination with a prandial insulin or oral antidiabetes drugs. In comparative clinical trials, detemir had a similar time-action profile and duration of action to another long-acting insulin analog, glargine, with less within-subject variability. Once-daily detemir was associated with no weight gain or less weight gain than comparator regimens. For patients who had not achieved glycemic control with a basal dose of once-daily detemir, adding a prandial insulin provided better glycemic control, less postprandial hypoglycemia, and a lower total daily dose of detemir than twice-daily detemir. Involvement of a multidisciplinary team and the use of a holistic approach for the treatment of T2DM patients are recommended to achieve and maintain the best patient outcomes.
CONCLUSION: Results from PK/PD, observational, and controlled clinical studies support a once-daily detemir regimen alone or in combination with a prandial insulin or oral antidiabetes drugs.
Authors:
Scott E Nelson
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Publication Detail:
Type:  Journal Article     Date:  2011-08-18
Journal Detail:
Title:  Clinical pharmacology : advances and applications     Volume:  3     ISSN:  1179-1438     ISO Abbreviation:  Clin Pharmacol     Publication Date:  2011  
Date Detail:
Created Date:  2012-01-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101564865     Medline TA:  Clin Pharmacol     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  27-37     Citation Subset:  -    
Affiliation:
Cleveland Family Medicine, Cleveland, Mississippi, USA.
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