The review summarises the available data from all glucose clamp studies available to date that have examined the time–action profiles of the two insulins. “Our findings confirm that Levemir® can be used once-daily by the vast majority of type 2 patients,” remarked Dr Tim Heise, chief executive officer, Clinical Science of the PROFIL Institute for Metabolic Research, Neuss, Germany and co-author of the review article. “We demonstrated that both products have a similar pharmacodynamic profile and therefore are equally suited for once daily dosing in this population,” he added.
The review also notes that Levemir® is associated with significantly less variability in its glucose-lowering effect in individual patients.1 This reduced within patient variability may lower the risk of hypoglycaemia with Levemir®.1
Clinical studies have also shown that Levemir® consistently leads to less weight gain than other long-acting insulins, including insulin glargine in combination with oral antidiabetic agents.2-15 The unique weight benefit of Levemir® has been reported in all 13 out of 13 published clinical studies comparing these insulins.3-15 Reduced weight gain may potentially provide patients with health benefits such as reduced cardiovascular risk.16
Dr Colm Galligan, Medical Director, Novo Nordisk UK says: "Novo Nordisk welcomes the findings of this review, that Levemir® is suitable for once daily use, its association with reduced variability in its glucose lowering effect, with potential for lowering the risk of hypoglycaemia, and, of course, its benefits in consistently leading to less weight gain. We are very proud that Levemir® is being recognised by experts such as Dr Heiss as a valuable modern insulin which has the potential to improve the quality of life for millions of people with diabetes."
About the review1
The review compared the glucose-lowering action profiles of Levemir® and insulin glargine by assessing results across 11 studies using an ‘isoglycaemic clamp’.
In these studies, following an injection of the study insulin, glucose levels are prevented from decreasing by introducing glucose through an infusion at a variable rate. The amount of glucose that is required to maintain blood glucose concentrations at the clamp level closely represents the glucose-lowering effect of the study insulin.
Some key findings of the review include:
- Levemir® and insulin glargine both have a gentle rise and fall in effect.1 A head-to-head comparison of the two insulins in people with type 2 diabetes reported nearly identical glucose-lowering profiles.17
- The duration of action for both insulins was dose-dependent and lasted 24 hours in patients with type 2 diabetes.1
Levemir® is a long-acting modern insulin (insulin analogue) that covers the body’s basal insulin need.2 Levemir® is released gradually and therefore it entails less fluctuation in blood glucose levels and better predictability compared to traditional long-acting NPH insulin.2 Levemir® in combination with OADs should be initiated with once-daily administration at a dose of 10 U or 0.1-0.2 U/kg and titrated based on individual patient needs.2 The dose should be taken in the evening, at dinner or before bedtime.4 Injections can be managed easily with the trusted, simple and safe FlexPen® insulin pen.18,19,20
Novo Nordisk is a healthcare company and a world leader in diabetes care. The company has the broadest diabetes product portfolio in the industry, including the most advanced products within the area of insulin delivery systems. In addition, Novo Nordisk has a leading position within areas such as haemostasis management, growth hormone therapy and hormone replacement therapy. Novo Nordisk manufactures and markets pharmaceutical products and services that make a significant difference to patients, the medical profession and society. With headquarters in Denmark, Novo Nordisk employs more than 25,300 employees in 79 countries, and markets its products in 179 countries. Novo Nordisk’s B shares are listed on the stock exchanges in Copenhagen and London. Its ADRs are listed on the New York Stock Exchange under the symbol ‘NVO’. For more information, visit novonordisk.com.
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- Heise T, Pieber TR. Towards peakless, reproducible and long-acting insulins. An assessment of the basal analogues based on isoglycaemic clamp studies. Diabetes Obes Metab. 2007; in press.
- Levemir®. Summary of Product Characteristics.
- Rosenstock J, et al. Insulin detemir added to oral anti-diabetic drugs in type 2 diabetes provides glycemic control comparable to insulin glargine with less weight gain. Diabetes 2006; 55: A132.
- Philis-Tsimikas A, et al. Comparison of once-daily insulin detemir with NPH insulin added to a regimen of oral antidiabetic drugs in poorly controlled type 2 diabetes. Clin Ther. 2006;28(10):1569-81.
- Hermansen K, et al. 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-naive people with type 2 diabetes. Diabetes Care 2006; 29(6): 1269–74.
- Russell-Jones D, et al. Effects of QD insulin detemir or neutral protamine Hagedorn on blood glucose control in patients with type 1 diabetes mellitus using a basal-bolus regimen. Clin Ther. 2004; 26(5): 724–36.
- Vague P, et al. Insulin detemir is associated with more predictable glycaemic control and reduced risk of hypoglycaemia than NPH insulin in patients with type 1 diabetes on a basal bolus regimen with premeal insulin aspart. Diabetes Care 2003; 26(3): 590–6.
- De Leeuw I, et al. Insulin detemir used in basal-bolus therapy 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. 2005; 7(1): 73–82.
- Pieber T, et al. Comparison of three multiple injection regimens for type 1 diabetes: morning plus dinner or bedtime administration of insulin detemir vs. morning plus bedtime NPH insulin. Diabetic Medicine 2005; 22(7): 850–57.
- Standl E, et al. The 12-month efficacy and safety of insulin detemir and NPH insulin in basal-bolus therapy for the treatment of type 1 diabetes. Diabetes Technology Therapeutics 2004; 6(5): 579–88.
- Home P, et al. Insulin detemir offers improved glycemic control compared with NPH insulin in people with type 1 diabetes: a randomized clinical trial. Diabetes Care 2004; 27(5): 1081–7.
- Hermansen K, et al. 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. Diabetologia 2004; 47(4): 622–9.
- Rašlova K, et al. Insulin detemir and insulin aspart: a promising basal-bolus regimen for type 2 diabetes. Diabetes Res Clin Pract. 2004; 66(2): 193–201.
- Haak T, et al. Lower within-subject variability of fasting blood glucose and reduced weight gain with insulin detemir compared to NPH insulin in patients with type 2 diabetes. Diabetes Obes Metab. 2005; 7(1): 56–64.
- Robertson K, et al. Insulin detemir compared with NPH insulin in children and adolescent with type 1 diabetes. Diabetic Medicine 2007; 24(1): 27.
- Ridderstråle M, et al. Obesity and cardiovascular risk factors in type 2 diabetes: results from the Swedish National Diabetes Register. J Intern Med 2006; 259(3): 314-22.
- Klein O, et al. Albumin-bound basal insulin analogues (insulin detemir and NN344) : comparable time-action profiles but less variability than insulin glargine in type 2 diabetes. Diabetes Obes Metab. 2007 May;9(3):290-9.
- IMS Health Worldwide Sales Data (July 2007).
- Niskanen L, et al. Randomized, multinational, open-label, 2-period, crossover comparison of biphasic insulin aspart 30 and biphasic insulin lispro 25 and pen devices in adult patients with type 2 diabetes mellitus. Clin Ther. 2004; 26: 531–40.
- Asakura T. Comparison of the dosing accuracy of two insulin injection devices. J Clin Res. 2005; 8: 33–40.
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