Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Paper
  • Published:

Can we reduce hypoglycaemia with insulin detemir?

International Journal of Obesity volume 28, pages S35–S40 (2004)Cite this article

Abstract

Tight glycaemic control is essential for reducing the risk of long-term diabetic complications in people with type I or II diabetes. Intensive blood-glucose control attempts to normalise both pre- and postprandial glycaemia, while avoiding severe hypoglycaemia. A basal insulin, providing a low level of insulin to cover postprandial and overnight fasting periods, is central to intensive blood-glucose control. However, hypoglycaemia, particularly nocturnal hypoglycaemia, is a major treatment-related complication of therapy with most basal insulins currently available for use in clinical practice. This is a result of pronounced peaks in absorption, which lead to inappropriate hyperinsulinaemia following evening administration, and especially poorly reproducible pharmacokinetic profiles when injected subcutaneously. Indeed, for many patients and health-care providers, concern around hypoglycaemia forms a critical barrier to the attainment of tight glycaemic control. Insulin detemir is a novel long-acting analogue of human insulin designed to overcome these practical limitations. Clinical evidence from comparative studies with NPH insulin shows that insulin detemir provides a consistent and clinically relevant reduction in hypoglycaemic risk, especially for nocturnal events, at equivalent or better levels of glycaemic control.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977–986.

  2. UK Prospective Diabetes Study group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet 1998; 352: 837–853.

  3. The DCCT Research Group. Epidemiology of severe hypoglycaemia in the Diabetes Control and Complications Trial. Am J Med 1991; 90: 450–459.

  4. The DCCT Research Group. Adverse events and their association with treatment regimens in the Diabetes Control and Complications Trial. Diabetes Care 1995; 18: 1415–1427.

  5. The DCCT Research Group. Implementation of treatment protocols in the Diabetes Control and Complications Trial. Diabetes Care 1995; 18: 361–375.

  6. Reichard P, Nilsson B-Y, Rosenquist U . The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus. N Engl J Med 1993; 329: 304–309.

    Article  CAS  Google Scholar 

  7. Mecklenburg RS, Benson EA, Benson JW Jr, Fredlund PN, Guinn T, Metz RJ, Nielsen RL, Sanner CA . Acute complications associated with insulin infusion pump therapy: report of experience with 161 patients. JAMA 1984; 252: 3265–3269.

    Article  CAS  Google Scholar 

  8. Cryer P . Hypoglycaemia is the limiting factor in the management of diabetes. Diabetes Metab Res Rev 1999; 15: 42–46.

    Article  CAS  Google Scholar 

  9. Korytowski M . When oral agents fail: practical barriers to starting insulin. Int J Obes Relat Metab Disord 2002; 26 (Suppl 3): S18–24.

    Article  Google Scholar 

  10. Allen KV, Frier BM . Nocturnal hypoglycaemia: clinical manifestations and therapeutic strategies towards prevention. Endocr Pract 2003; 9: 530–543.

    Article  Google Scholar 

  11. Heise T, Nosek L, Ronn BB, Endahl L, Heinemann L, Kapitza C, Draeger E . Lower within-subject variability of insulin determir in comparison to NPH insulin and insulin glargine in people with type 1 diabetes. Diabetes 2004; 53: 1614–1620.

    Article  CAS  Google Scholar 

  12. Pieber T, Plank J, Goerzer E, Sommer R, Wutte A, Sinner F, Bodenlenz M, Endahl L, Draeger E, Zdravkovic M . Duration of action, pharmacodynamic profile and between-subject variability of insulin detemir in subjects with type 1 diabetes. Diabetes 2002; 51: A53.

    Article  Google Scholar 

  13. Russell-Jones D, Draeger E, Simpson R . Effects of once daily insulin detemir or NPH insulin on blood glucose control in people with type 1 diabetes using a basal-bolus regimen. Clin Ther 2004; 26: 724–736.

    Article  CAS  Google Scholar 

  14. Standl E, Lang H, Roberts A . The 12-month efficacy and safety of insulin detemir and NPH insulin in basal bolus therapy for the treatment of type 1 diabetes. Diabetes Technol Ther, (in press).

  15. Vague P, Selam J-L, Skeie S, De Leeuw I, Elte JW, Haahr H, Kristensen A, Draeger E . Insulin detemir is associated with more predictable glycemic control and reduced risk of hypoglycemia than NPH insulin in patients with type 1 diabetes on a basal-bolus regimen with premeal insulin aspart. Diabetes Care 2003; 26: 590–596.

    Article  CAS  Google Scholar 

  16. De Leeuw I, Vague P, Selam J-L, Skeie S, Lang H, Draeger E, Elte JWF . Insulin detemir used in people with type 1 diabetes is associated with a lower risk of nocturnal hypoglycaemia and less weight gain over 12 months in comparison to NPH insulin. Diabetes Obes Metab, (in press).

  17. Heinemann L, Sinha K, Weyer C, Loftager M, Hirschberger S, Heise T . Time-action profile of the soluble, fatty acid acylated, long-acting insulin analogue NN304. Diabetes Med 1999; 16: 332–338.

    Article  CAS  Google Scholar 

  18. Hermansen K, Madsbad S, Perrild H, Kristensen A, Axelsen M . Comparison of the soluble basal insulin analog insulin detemir with NPH insulin. Diabetes Care 2001; 24: 296–301.

    Article  CAS  Google Scholar 

  19. Kølendorf K, Pavlic-Renar I, Santeusanio F, Philotheou A, Gall M-A, Heller S . Insulin detemir is associated with lower risk of hypoglycaemia compared to NPH insulin in people with type 1diabetes. Diabetes 2004; 53 (Suppl 2): A130.

    Google Scholar 

  20. The DCCT Research Group. Effect of intensive diabetes treatment on the development and progression of long term complications in adolescents with insulin dependent diabetes mellitus: Diabetes Control and Complications Trial. J Paediatr 1994; 125: 177–188.

  21. Rosenbloom AL, Schatz DA, Krischer JP, Skyler JS, Becker DJ, Laporte RE, Libman I, Pietropaolo M, Dosch HM, Finberg L, Muir A, Tamborlane WV, Grey M, Silverstein JH, Malone JI . Therapeutic controversy: prevention and treatment of diabetes in children. J Clin Endocrinol Metab 2000; 85: 494–522.

    Article  CAS  Google Scholar 

  22. Ryan C, Vega A, Drash A . Cognitive deficits in adolescents who developed diabetes early in life. Pediatrics 1985; 75: 921–927.

    CAS  Google Scholar 

  23. Rovet J, Ehrlich RM, Hoppe M . Intellectual deficits associated with early onset of insulin dependent diabetes mellitus in children. Diabetes Care 1987; 10: 510–515.

    Article  CAS  Google Scholar 

  24. The Diabetes Control and Complications Trial Research Group. Hypoglycaemia in the diabetes control and complications trial. Diabetes 1997; 46: 271–286.

  25. Robertson K, Scholne E, Gucev Z, Mordhorst L, Tamer SC, Gall M-A, Ludvigsson J . Benefits of insulin detemir over NPH insulin in children and adolescents with type 1 diabetes: lower and more predictable fasting plasma glucose and lower risk of nocturnal hypoglycaemia. Diabetes 2004; 53 (Suppl 2): A144.

    Google Scholar 

  26. Hermansen K, Fontaine P, Kukolja KK, Peterkova V, Leth G, Gall MA . Basal-bolus therapy with insulin analogues (insulin detemir and insulin aspart) versus traditional human insulins (NPH insulin and regular human insulin) in patients with type 1 diabetes. Diabetologia 2004; 47: 622–629.

    Article  CAS  Google Scholar 

  27. Haak T, Tiengo A, Draeger E, Suntum M, Waldhäusl W . Lower within-subject variability of fasting blood glucose and reduced weight gain with insulin detemir compared with NPH insulin in patients with type 2 diabetes. Diabetes Obes Metab, (in press).

  28. Pieber TR, Grill V, Kristensen A, Draeger E . Timing of dose-administration of insulin detemir is flexible and results in lower and less variable glucose levels and less weight gain than NPH insulin. Diabet Med, (in press).

  29. Home P, Bartley P, Russell-Jones D, Hanaire-Broutin H, Heeg JE, Abrams P, Landin-Olsson M, Hylleberg B, Lang H, Draeger E, Study to Evaluate the Administration of Detemir Insulin Efficacy, Safety and Suitability (STEADINESS) Study Group. Insulin detemir offers improved glycaemic control compared to NPH insulin in people with type 1 diabetes: a randomized clinical trial. Diabetes Care 2004; 27: 1081–1087.

    Article  CAS  Google Scholar 

  30. Raslova K, Bogoev A, Raz I, Lethh G, Gall M-A . Insulin detemir and insulin aspart: a promising basal-bolus regimen for type 2 diabetes. Diabetes Res Clin Pract, (in press).

Download references

Author information

Authors and Affiliations

  1. Department of Endocrinology, Katholieke Universitet, Leuven, UZ Gasthuisberg O&N, Leuven, B-3000, Belgium

    C Mathieu

Authors
  1. C Mathieu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C Mathieu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mathieu, C. Can we reduce hypoglycaemia with insulin detemir?. Int J Obes 28 (Suppl 2), S35–S40 (2004). https://doi.org/10.1038/sj.ijo.0802748

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijo.0802748

Keywords

This article is cited by

Search

Advanced search

Quick links