Insulin Detemir: A Review of Its Use in the Management of Type 1 and 2 Diabetes Mellitus

Chapman TM, Perry CM. Drugs. 2004;64:2577-2595.

Insulin detemir (Levemir^®) is the first of a new class of long-acting insulin analogs for use as basal insulin therapy in type 1 and type 2 diabetes. The pharmacologic and clinical characteristics of insulin detemir are detailed in this review.

Insulin detemir has a slow rate of absorption and long duration of action of up to 24 hours, attributable to a 14-carbon fatty acid chain that can reversibly bind to human albumin. In plasma, 99% of insulin detemir is bound with albumin. Unlike NPH insulin and insulin glargine, insulin detemir is soluble at a neutral pH and therefore exists as a liquid depot following sc injection. This results in reduced variability in glycemic control. Compared with NPH and insulin glargine, insulin detemir has a glucose-lowering profile that is smoother, is longer, and has less intrapatient variation. Further, the pharmacokinetic profile of insulin detemir is more predictable than that of NPH insulin.

The efficacy of insulin detemir as part of a basal-bolus regimen compared with NPH insulin has been evaluated in a number of large (N>250), randomized, nonblind trials up to 26 weeks in length. In both type 1 and type 2 diabetes, patients treated with insulin detemir have achieved comparable or better glycemic control and achieved fasting plasma glucose levels similar to or lower than patients treated with NPH. In type 1 diabetes, treatment with insulin detemir is not associated with increased bodyweight compared with NPH insulin. In type 2 diabetes, insulin detemir has been found to be associated with significantly less weight gain compared with NPH insulin.

In general, insulin detemir is well tolerated. The risk of hypoglycemia with insulin detemir is similar to or lower than the risk associated with NPH insulin. Also, a significantly reduced risk of nocturnal hypoglycemia with insulin detemir has been found in comparison with NPH insulin. Additional adverse events include headache, upper respiratory tract infection, and rhinitis.

Further studies can help to determine the long-term effects (>1 year) of insulin detemir on morbidity and mortality, as well as the efficacy of insulin detemir compared with insulin glargine. Further research on the pharmacoeconomics of insulin detemir and on the efficacy of insulin analogs compared with insulin pump use are also needed.