Insulin detemir
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| Insulin detemir
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| Systematic (IUPAC) name | |
| ? | |
| Identifiers | |
| CAS number | |
| ATC code | A10 |
| PubChem | ? |
| Chemical data | |
| Formula | C267H402N64O76S6 |
| Mol. mass | 5913 |
| Pharmacokinetic data | |
| Bioavailability | 60% (when administered s.c.) |
| Metabolism | ? |
| Half life | 5-7 hours |
| Excretion | ? |
| Therapeutic considerations | |
| Pregnancy cat. |
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Insulin detemir is a long-lasting human insulin analogue for maintaining the basal level of insulin. Novo Nordisk markets it under the trade name Levemir. It is an insulin analogue in which to the lysine amino acid at position B29 a fatty acid (myristic acid) is bound. It is quickly resorbed after which in the blood it binds to albumin through the fat acid at position B29. It then slowly dissociates from this complex.
In a clinical study (see ref 2) which compared the efficacy and safety of using Levemir for the treatment of patients with type 2 diabetes who had suboptimal glycemic control while receiving maximally tolerated doses of metformin and sulfonylurea (common tablet therapies for type 2 diabetes), it was found that, "At 24 weeks, A1C (glycosylated hemoglobin) had decreased by 1.8 and 1.9% (from 8.6 to 6.8 and from 8.5 to 6.6%) for detemir and NPH, respectively (NS). In both groups, 70% of participants achieved an A1C of 7.0%, but the proportion achieving this without hypoglycemia was higher with insulin detemir than with NPH insulin (26 vs. 16%, P = 0.008). Compared with NPH insulin, the risk for all hypoglycemia with insulin detemir was reduced by 47% (P < 0.001) and nocturnal hypoglycemia by 55% (P < 0.001). Mean weight gain was 1.2 kg with insulin detemir and 2.8 kg with NPH insulin (P < 0.001), and the difference in baseline-adjusted final weight was –1.58 (P < 0.001)."
In short, it was found that insulin detemir reduced Hemoglobin A1C to target levels of 7.0% for 70% of patients, similar to human basal insulin NPH, but without the same risk of hypoglycemia (low blood sugar) and with much lower weight gain.
Similar results have been seen in type 1 diabetes (see ref 3.)
References
1. http://content.nejm.org/cgi/content/full/NEJMoa075392, Addition of Biphasic, Prandial, or Basal Insulin to Oral Therapy in Type 2 Diabetes; Rury R. Holman, M.B., Ch.B., F.R.C.P., Kerensa I. Thorne, M.Sc., Andrew J. Farmer, D.M., F.R.C.G.P., Melanie J. Davies, M.D., F.R.C.P., Joanne F. Keenan, B.A., Sanjoy Paul, Ph.D., Jonathan C. Levy, M.D., F.R.C.P., for the 4-T Study Group
2. http://care.diabetesjournals.org/cgi/content/abstract/29/6/1269?ijkey=2e8d412f27ded6ae0a205b3bfd4d3608ed9b64b5&keytype2=tf_ipsecsha , A 26-Week, Randomized, Parallel, Treat-to-Target Trial Comparing Insulin Detemir With NPH Insulin as Add-On Therapy to Oral Glucose-Lowering Drugs in Insulin-Naïve People With Type 2 Diabetes, Kjeld Hermansen, MD1, Melanie Davies, MD2, Taudeusz Derezinski, MD3, Gabrielle Martinez Ravn4, Per Clauson4, Philip Home, DM, DPHIL5 on behalf of the Levemir Treat-to-Target Study Group
3. http://www.springerlink.com/content/6lktug1r2exurq0j/?p=af5e2f613a0f4c6690f8fdc920f48bd6&pi=5 , Insulin analogues (insulin detemir and insulin aspart) versus traditional human insulins (NPH insulin and regular human insulin) in basal-bolus therapy for patients with Type 1 diabetes, Journal Diabetologia, Issue Volume 47, Number 4 / April, 2004.
External links
Oral antidiabetic drugs and Insulin analogs (A10) | |
|---|---|
| Biguanides | Metformin |
| Sulfonylureas | Chlorpropamide, Glibenclamide (Glyburide), Gliclazide, Glimepiride, Glipizide, Gliquidone, Tolazamide, Tolbutamide |
| Alpha-glucosidase inhibitors | Acarbose, Miglitol, Voglibose |
| Thiazolidinediones (TZD) | Pioglitazone, Rivoglitazone†, Rosiglitazone, Troglitazone‡ |
| Meglitinides | Nateglinide, Repaglinide, Mitiglinide |
| Dipeptidyl peptidase-4 (DPP-4) inhibitors | Alogliptin†, Saxagliptin†, Sitagliptin, Vildagliptin, Linagliptin† |
| Glucagon-like peptide-1 analog | Exenatide, Liraglutide†, Albiglutide† |
| Amylin analog | Pramlintide |
| Insulin analogs | fast acting (Insulin lispro, Insulin aspart, Insulin glulisine), long acting (Insulin glargine, Insulin detemir) |
| Dual PPAR agonists | Aleglitazar†, Muraglitazar§, Tesaglitazar§ |
| SGLT2 inhibitor | Dapagliflozin†, Remogliflozin† |
| †Undergoing clinical trials. ‡ Withdrawn from market. §Development halted. | |
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
