Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011860 (type 2 diabetes)
 57,723 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Insulin detemir (Levemir) is a soluble long-acting human insulin analogue acylated with a 14-carbon fatty acid. The fatty acid modification allows insulin detemir to reversibly bind to albumin, thereby providing slow absorption and a prolonged and consistent metabolic effect of up to 24 hours in patients with type 1 or type 2 diabetes mellitus. Insulin detemir has a more predictable, protracted and consistent effect on blood glucose than neutral protamine Hagedorn (NPH) insulin, with less intrapatient variability in glycaemic control, compared with NPH insulin or insulin glargine. Insulin detemir, administered once or twice daily, is at least as effective as NPH insulin in maintaining overall glycaemic control, with a similar or lower risk of hypoglycaemia, especially nocturnal hypoglycaemia, compared with NPH insulin in patients with type 1 or type 2 diabetes. Insulin detemir also provides the added clinical benefit of no appreciable bodyweight gain in patients with type 1 diabetes and less bodyweight gain than NPH insulin in patients with type 2 diabetes. Insulin detemir is, therefore, a promising new option for basal insulin therapy in patients with type 1 or 2 diabetes.
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PMID:Insulin detemir: a review of its use in the management of type 1 and 2 diabetes mellitus. 1551 57

Insulin detemir (Levemir) is a soluble long-acting human insulin analog acylated with a 14-carbon fatty acid. The fatty acid modification allows insulin detemir to reversibly bind to albumin, thereby providing slow absorption and a prolonged and consistent metabolic effect of up to 24 hours in patients with type 1 or type 2 diabetes mellitus. Insulin detemir has a more predictable, protracted, and consistent effect on blood glucose than neutral protamine Hagedorn (NPH) insulin, with less intrapatient variability in glycemic control than NPH insulin or insulin glargine. Insulin detemir, administered once or twice daily, is at least as effective as NPH insulin in maintaining overall glycemic control, with a similar or lower risk of hypoglycemia, especially nocturnal hypoglycemia, compared with NPH insulin in patients with type 1 or type 2 diabetes. Insulin detemir also provides the added clinical benefit of no appreciable bodyweight gain in patients with type 1 diabetes and less bodyweight gain than NPH insulin in patients with type 2 diabetes. Insulin detemir is, therefore, a promising new option for basal insulin therapy in patients with type 1 or 2 diabetes.
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PMID:Spotlight on insulin detemir in type 1 and 2 diabetes mellitus. 1569 Dec 19

Insulin detemir (Levemir) is a soluble long acting human insulin analogue acylated with a 14-carbon fatty acid. The fatty acid modification allows insulin detemir to reversibly bind to albumin, thereby providing slow absorption and a prolonged metabolic effect (up to 24 hours) with low variability. Indeed, in patients with type 1 or type 2 diabetes mellitus, insulin detemir has a more predictable, protracted and consistent effect, with less intrapatient variability in glycaemic control (particularly fasting plasma glucose levels), compared with NPH (Neutral Protamine Hagedorn) insulin. Insulin detemir, is at least as effective as NPH insulin in maintaining overall glycaemic control, with a lower risk of nocturnal hypoglycaemia. It also provides the additional benefit of less body weight gain as compared to other basal insulins. Levemir, presented in cartridges for the pen device NovoPen 3 and administered preferably at bedtime (if necessary morning and evening), is a promising new option for basal insulin therapy in diabetic patients, especially those on a basal-bolus scheme.
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PMID:[Insulin detemir (Levemir)]. 1635 71

Basal insulin therapy is an integral part of the intensive management of type 1 diabetes and it is also often used in type 2 diabetes. An ideal insulin regimen in patients with diabetes would mirror the 24-h insulin profile of a non-diabetic person, thereby preventing hyperglycaemia without inducing hypoglycaemia. Until recently, available insulins have pharmacokinetic disadvantages, compared to physiological insulin secretion. Insulin detemir is a new basal insulin analogue recently available for commercial use in the UK. Clinical trials have demonstrated lower fasting plasma glucose levels, lower variability in plasma glucose, predictable action profile and a reduced risk of nocturnal hypoglycaemia and weight gain, compared to conventional basal insulins. This study reviews the properties and potential use of insulin detemir.
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PMID:Insulin detemir: a new basal insulin analogue. 1636 79

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.
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PMID:Is insulin detemir able to favor a lower variability in the action of injected insulin in diabetic subjects? 1638 96

(1) The standard treatment for type 1 diabetes is intensive insulin therapy, consisting of at least 3 daily injections of different insulins, one of which is a long-acting insulin. (2) Insulin detemir is the second long-acting human insulin analogue to be marketed in Europe (after insulin glargine) for the treatment of diabetes in adults and children over 6 years of age. Its action lasts about 12 hours. (3) Insulin detemir was evaluated in around 10 comparative trials, all unblinded, examining the effect of insulin detemir in terms of global glycaemic control (HbA1c level). None of these trials examined whether insulin detemir prevented complications of diabetes. (4) About 10 trials, involving more than 3000 patients, showed that insulin detemir, insulin isophane and insulin glargine have similar efficacy in treating both type 1 and type 2 diabetes. (5) The short-term adverse effect profile of insulin detemir is similar to that of isophane insulin. There is slightly less weight gain with insulin detemir, but injection site reactions occur more frequently. The long-term adverse effects of insulin detemir are not known. (6) Insulin detemir is a clear solution, leading to a risk of confusion with ordinary human insulin or a fast-acting insulin analogue. (7) In practice, isophane insulin remains the first choice long-acting insulin for patients with type 1 or type 2 diabetes.
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PMID:Insulin detemir: new drug. A second long-acting insulin analogue: many uncertainties, few advantages. 1712 Dec 10

PREDICTIVE (Predictable Results and Experience in Diabetes through Intensification and Control to Target: An International Variability Evaluation) is a large, multi-national, open-label, prospective, observational study assessing the safety and efficacy of insulin detemir in clinical practice. A total of 20,531 patients with type 1 or 2 diabetes from 11 countries were prescribed insulin detemir and followed up after a mean of 14.4 weeks. The primary endpoint was incidence of serious adverse drug reactions (SADRs), including major hypoglycaemia. Secondary endpoints were: haemoglobin A(1c) (HbA(1c)), mean self-monitored fasting glucose, within-patient fasting glucose variability and body weight change. Two hundred and fourteen patients (1%) reported SADRs, including major hypoglycaemia. The incidence of major hypoglycaemic episodes was reduced from 3.0/patient-year at baseline to 0.7/patient-year at follow-up in type 1 patients (p < 0.0001), and from 0.8 to 0.1/patient-year in type 2 patients (p < 0.0001). Insulin detemir improved glycaemic control in type 1 and type 2 patients, with reductions in mean HbA(1c) (0.5% and 0.9%, respectively, p < 0.0001 for both), fasting glucose (1.7 and 2.6 mmol/l, p < 0.0001 for both) and within-patient fasting glucose variability (0.7 and 0.5 mmol/l, p < 0.0001 for both). There was a small decrease in mean body weight in both type 1 and 2 patients (-0.1 kg, p < 0.01 and -0.4 kg, p < 0.0001 respectively). Insulin detemir was used once- or twice-daily in 49% and 50% of type 1 patients, and 77% and 23% of type 2 diabetes patients, respectively. The 14-week observations from PREDICTIVE support clinical trial data showing that insulin detemir improves glycaemic control, with a lowered risk of hypoglycaemia and no weight gain.
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PMID:Safety and efficacy of insulin detemir in clinical practice: 14-week follow-up data from type 1 and type 2 diabetes patients in the PREDICTIVE European cohort. 1731 28

Weight gain is often perceived as inevitable with insulin therapy, particularly as we strive for tight glycaemic control and are using increasingly proactive insulin titration regimes. The United Kingdom Prospective Diabetes Study documented that weight gain occurs most rapidly soon after insulin therapy is first initiated. The timing of this side effect is particularly undesirable, as weight gain may interfere with patients' adjustment to insulin therapy and may undermine appropriate diabetes self-management behaviours. Until recently, many patients had little alternative other than to accept unwanted weight gain if they were to achieve sufficient glycaemic control to reduce risk of chronic complications of diabetes. Insulin detemir is a novel basal insulin analogue that has consistently been shown in randomized, controlled trials to have a weight-sparing effect (i.e. weight loss or reduced weight gain compared with other insulins) in both type 1 and type 2 diabetes. Indeed, unlike neutral protamine Hagedorn (NPH) insulin, the weight-sparing effect of insulin detemir appears to be most prominent in people who are the most obese. The mechanisms behind the weight-sparing effect of insulin detemir are still being clarified. Reduced risk of hypoglycaemia with insulin detemir, coupled with a more consistent and reliable delivery of the desired dose than is available with traditional basal insulin, such as NPH, has been proposed to minimize defensive snacking by patients, and help to limit weight gain. However, even if this was proven, it would be unlikely to fully explain the weight-sparing effect of insulin detemir. Two additional theories have been put forward. One suggests that due to its novel method of prolonging action via acylation and albumin binding, insulin detemir may differentially influence hepatocytes more than peripheral tissues, thus effectively suppressing hepatic glucose output without promoting lipogenesis in the periphery. The second theory suggests that insulin detemir may be more effective than human insulin in communicating satiety signals within the central nervous system. Further clarification of these hypotheses is required.
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PMID:Does insulin detemir have a role in reducing risk of insulin-associated weight gain? 1739 Nov 47

In the treatment of patients with diabetes, the tear of hypoglycemia is a major barrier to initiating, maintaining, and/or intensifying insulin therapy. Insulin detemir (Levemir [Novo Nordisk A/S, Bagsvaerd, Denmark]) is a novel, long-acting, basal insulin analog associated with a reduced risk of hypoglycemia that is available to improve glycemic control. This article discusses clinical trial data on the safety and efficacy of insulin detemir in patients with type 1 and type 2 diabetes. In additions, results from the German cohort of the Predictable Results and Experience in Diabetes through Intensification and Control to Target: An International Variability Evaluation (PREDICTIVE study, a large, multinational observational study examining the clinical effectiveness and safety of insulin detemir, are reviewed. Finally, an evaluation of these data serves to show how the highly predictable action of insulin detemir translates into effective glycemic control with a lower incidence of hypoglycemia.
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PMID:Efficacy and safety of insulin detemir. 1788 29

Forty-three case reports of patients with type 2 diabetes who were treated with insulin detemir (Levemir, Novo Nordisk A/S, Bagsvaerd, Denmark) were collected from doctors' offices for the purpose of analyzing 4 parameters: (1) effectiveness of glycemic control (fasting blood glucose [FBG] readings and glycosylated hemoglobin [A1C]); (2) tolerability (hypoglycemic episodes and weight gain); (3) dosing regimen; and (4) treatment discontinuations. Patients in the Levemir Early Clinical Experience Case Series showed improvement of mean FBG readings, with a mean decrease of 63 mg/dL from baseline by the third follow-up visit (24-41) weeks from treatment initiation). Mean A1C values decreased during this time from a baseline average of 8.6% to a final average of 7.0%. Four patients on insulin detemir reported hypoglycemic episodes, none of which required special interventions or discontinuation of treatment. A mean weight loss of 5 lb was observed at the final follow-up visit. Twenty-four (55.8%) patients were insulin-naive, and 19 (44.2%) were already on insulin at the time they were started on insulin detemir. Almost 91% of patients were on a once-daily regimen of insulin detemir; 4 patients discontinued treatment during the observation period. Overall, the observations from the Levemir Early Clinical Experience Case Series are good indicators of the early experience with insulin detemir in the United States, and are consistent with findings from controlled trials and large observational studies.
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PMID:Levemir Early Clinical Experience Case Series. 1788 31


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