Abstract
Background and objective: Iowa Care (Iowa Medicaid), USA, switched insulin glargine to insulin detemir in subjects with diabetes mellitus without the approval of healthcare providers. This study set out to examine the impact of transition on parameters of diabetes management in type 1 diabetes.
Methods: This was a retrospective review of the records of subjects with type 1 diabetes up to August 2007 in whom transition occurred. Subjects completing 6 months of insulin detemir therapy were included. Twenty-four subjects switching from insulin glargine to insuline detemir (group 1) fulfilled the duration with insulin detemir. Glycaemic control (glycosylated haemoglobin [HbA1c]), bodyweight, daily insulin dose (units), total and insulin glargine or insulin detemir and rapid-acting insulin aspart and hypoglycaemic events during the last 4 weeks, pre-switch and again at 6 months post-switch were assessed. Records of 21 agematched subjects and continuing insulin glargine for 6 months (group 2) were examined. Subjects switched from insulin glargine to insulin detemir in the same daily dose. The daily doses of insulin detemir and aspart in group 1 were adjusted by telephone weekly based on blood glucose monitoring until stabilization occurred. Subjects were followed up in the outpatient clinic every 3 months.
Results: Subjects in group 1 changed to insulin detemir twice a day because of a significant rise in hypoglycaemia with the daily dose used once a day. Glycaemic control remained stable on continuing insulin glargine; HbAic 7.6 ± 0.3 to 7.8 ± 0.3%, while it worsened on switching to insulin detemir; HbA1c 7.9 ± 0.6 to 8.8 ± 0.8 despite a higher daily dose; insulin detemir 46 ± 9 U/day versus pre-switch insulin glargine 36 ± 8 U/day and group 2 insulin glargine 35 ± 6 U/day; and greater total insulin dose: 80±12 U/day versus 68 ± 10 pre-switch and group 2 insulin glargine 62 ± 10 U/day (p < 0.05 for all comparisons). Bodyweight and hypoglycaemic events were not significantly different pre- and post-switch.
Conclusion: Switching to insulin detemir from glargine is likely to result in lapse of glycaemic control despite a higher daily insulin dose, increased number of injections and need for frequent evaluations.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bott S, Tusek C, Jacobsen LV, et al. Insulin detemir under steady-state conditions: no accumulation and constant metabolic effect over time with twice daily administration in subjects with type 1 diabetes. Diabet Med 2006; 23(5): 522–8
Pieber TR, Treichel HC, Hompesch B, et al. Comparison of insulin detemir and insulin glargine in subjects with type 1 diabetes using intensive insulin therapy. Diabet Med 2007; 24(6): 635–42
Dornhorst A, Luddeke HJ, Sreenan S, et al. 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. Int J Clin Pract 2007; 61(3): 523–8
Gilmer TP, O’Conner PJ, Manning WG, et al. The cost to health plans of poor glycemic control. Diabetes Care 1997; 20(120): 1847–53
Gray A, Raikoi M, McGuire A, et al. Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes; economic analysis alongside randomized controlled trial (UKPDS 41). BMJ 2000; 320: 1373–8
Testa MA, Simonson DC. Health economic benefits and quality of life during improved glycemic control in patients with type 2 diabetes mellitus: a randomized, controlled, double-blind trial. JAMA 1998; 208: 1490–6
Adler AI, Stratton IM, Neil HAW, et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ 2000; 321: 412–9
Skyler JS. Diabetic complications: the importance of glucose control. Endocrinol Metab Clin North Am 1996; 252(2): 243–54
DCCT Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329(14): 977–86
Ohkubo Y, Kishikawa H, Araki E, et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract 1995; 28(2): 103–17
UKPDS. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 353(9131): 837–53
Acknowledgements
These data were presented in part at the annual meeting of the American Diabetes Association in Chicago, IL, USA, in June 2007 (abstract no. 07LB) and at the annual meeting of the European Association for the Study of Diabetes in Rome, Italy in September 2008 (abstract no. 970).
No sources of funding were used to assist in the preparation of this article. The author has been on the Speaker’s Bureau for sanofi-aventis. The author is grateful to Mackenzie Pedersen for her secretarial assistance in the preparation of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kabadi, U.M. Deleterious Outcomes after Abrupt Transition from Insulin Glargine to Insulin Detemir in Patients with Type 1 Diabetes Mellitus. Clin. Drug Investig. 28, 697–701 (2008). https://doi.org/10.2165/00044011-200828110-00003
Published:
Issue Date:
DOI: https://doi.org/10.2165/00044011-200828110-00003