Insulin detemir and its place in the diabetes treatment: results of 15-year use


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Abstract

Insulin detemir (Levemir) is a long-acting basal insulin analogue for the treatment of patients with type 1 and type 2 diabetes mellitus (DM1, DM2). The prolonged effect of insulin detemir is associated with its high ability to self-association and the possibility of a reversible connection with albumin in both subcutaneous fat and plasma, which slows down its systemic absorption from the injection sites and provides a buffering effect and low variability of action. Numerous randomized, open, multi-center studies have shown the positive effect of insulin detemir on glycemic control using this basal insulin analogue in combination with oral hypoglycemic therapy and in baseline bolus therapy for DM1 and DM2 patients. Compared with neutral protamine Hagedorn (NPH) insulin or insulin glargine, insulin detemir showed similar effectiveness according to the glycated hemoglobin (HbA1c) level, with a lower variability, which determined a significantly lower risk of developing hypoglycemic episodes, including nocturnal hypoglycemia in DM1 and DM2 patients. An additional advantage of insulin detemir was significantly lower patient weight gain compared with NPH insulin and insulin glargine. The results of studies of patients aged 2-16 or 6-17 years have shown that the inclusion of insulin detemir in the baseline-bolus mode of insulin therapy for children and adolescents is more effective and safe compared to NPH insulin and insulin glargine. Positive results were demonstrated in pregnant women with DM1. Maternal and neonatal outcomes on insulin detemir therapy were similar to the outcomes observed with NPH insulin treatment in terms of their effectiveness, but with a lower incidence of hypoglycemic conditions, which determines the greater safety of this drug. Insulin detemir has proved its worth as basal insulin therapy in older DM1 and DM2 patients with comorbid pathology. Thus, insulin detemir may become the best option for use as a basal insulin therapy and as a part of the basis-bolus insulin therapy of DM1 and DM2 patients of different age groups.

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About the authors

Yana V. Girsh

Surgut State University of the Khanty-Mansiysk Autonomous Okrug - Yugra

Email: yanaef@yandex.ru
Medical Institute, MD, Professor Surgut, Russia

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