Insulin detemir

Insulin detemir
Clinical data
Trade names Levemir
AHFS/Drugs.com Monograph
MedlinePlus a606012
License data
Pregnancy
category
  • US: B (No risk in non-human studies)
    Routes of
    administration    		 Subcutaneous
    ATC code
    Legal status
    Legal status
    Pharmacokinetic data
    Bioavailability 60% (when administered s.c.)
    Elimination half-life 5–7 hours
    Identifiers
    CAS Number
    DrugBank
    ChemSpider
    • none
    UNII
    KEGG
    Chemical and physical data
    Formula C267H402N64O76S6
    Molar mass 5913 g/mol
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    Insulin detemir is a long-acting 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 a fatty acid (myristic acid) is bound to the lysine amino acid at position B29. It is quickly absorbed after which it binds to albumin in the blood through its fatty acid at position B29. It then slowly dissociates from this complex.

    In a clinical study[1] that 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, HbA1c (glycated 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 HbA1c 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 HbA1c to target levels of 7.0% for 70% of patients, similar to human basal insulin, NPH, but without the same risk of hypoglycemia and with somewhat less weight gain.

    Regarding weight gain compared to NPH insulin, the Levemir package insert states the following disclaimer:

    "LEVEMIR was associated with somewhat less weight gain than NPH (Table 4). Whether these observed differences represent true differences in the effects of LEVEMIR and NPH insulin is not known, since these trials were not blinded and the protocols (e.g., diet and exercise instructions and monitoring) were not specifically directed at exploring hypotheses related to weight effects of the treatments compared. The clinical significance of the observed differences has not been established..."Levemir Package Insert; Adverse Reactions > Weight Gain

    In addition, the safety and efficacy of insulin detemir (Levemir®) in real life clinical practice was evaluated in the A1chieve study.

    On June 13, 2009, the U.S. Food and Drug Administration (FDA) issued a public health advisory for Levemir insulin after learning that 129,000 stolen vials reappeared and were being sold in the U.S. market. The FDA warned that the stolen vials "may not have been stored and handled properly and may be dangerous for patients to use." The stolen vials were identified as lots XZF0036, XZF0037, and XZF0038.

    References

    1. ↑ 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, (2006) 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

    1. http://content.nejm.org/cgi/content/full/NEJMoa075392, Addition of Biphasic, Prandial, or Basal Insulin to Oral Therapy in Type 2 Diabetes; (2006) 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://www.springerlink.com/content/6lktug1r2exurq0j/?p=af5e2f613a0f4c6690f8fdc920f48bd6&pi=5, (2007) 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, volume 47, number 4 / April, 2004.

    • Levemir US website
    • Levemir Package Insert
    • A1chieve study in insulin a 60 000-person, global, prospective, observational study of basal, meal-time, and biphasic insulin analogs in daily clinical practice
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