Evaluation of Unit Equivalency of Insulin Glargine to Insulin Detemir in an Acute Care Setting

Overview

Journal J Pharm Technol

Publisher Sage Publications

Date 2021 Dec 3

PMID 34861013

Authors

Elizabeth A Cook

Taylor Gill

Scott Taylor

Affiliations

Soon will be listed here.

Abstract

Insulin glargine and insulin detemir are the most commonly prescribed basal insulins in the United States. While these analogs chemically differ, clinical trials have established no significant difference in efficacy. However, controversy remains as to whether the 2 agents are comparable with regard to unit equivalency. To determine the ratio of glucose lowering between insulin detemir and insulin glargine. This institutional review board-approved, single-center, retrospective, case-crossover study was conducted in patients with diabetes mellitus with inpatient admissions between June 30, 2014, to July 1, 2015. Patients must have received both insulin detemir and insulin glargine on either the same or separate hospital visits. A blood glucose-lowering ratio for both insulin glargine and insulin detemir was calculated for each patient based off of up to 5 days of fasting blood glucose values and the total number of units of insulin administered. Fifty-two patients were included in this study. No significant difference was found in the blood glucose-lowering ratio between insulin glargine (0.23 mg/dL/unit) as compared with insulin detemir (0.16 mg/dL/unit; = .08). No difference was found in the blood glucose-lowering ratio between insulin glargine and insulin detemir. The results of this study suggest that conversion between insulin glargine and insulin detemir using a 1:1 ratio in an acute care setting may be appropriate.

References

Meneghini L, Kesavadev J, Demissie M, Nazeri A, Hollander P . Once-daily initiation of basal insulin as add-on to metformin: a 26-week, randomized, treat-to-target trial comparing insulin detemir with insulin glargine in patients with type 2 diabetes. Diabetes Obes Metab. 2013; 15(8):729-36. DOI: 10.1111/dom.12083. View

Lucidi P, Porcellati F, Rossetti P, Candeloro P, Cioli P, Marzotti S . Pharmacokinetics and pharmacodynamics of therapeutic doses of basal insulins NPH, glargine, and detemir after 1 week of daily administration at bedtime in type 2 diabetic subjects: a randomized cross-over study. Diabetes Care. 2011; 34(6):1312-4. PMC: 3114339. DOI: 10.2337/dc10-1911. View

Moghissi E, Korytkowski M, DiNardo M, Einhorn D, Hellman R, Hirsch I . American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care. 2009; 32(6):1119-31. PMC: 2681039. DOI: 10.2337/dc09-9029. View

Zhang T, Lin M, Li W, Fan X, Du T, Zhao Y . Comparison of the Efficacy and Safety of Insulin Detemir and Insulin Glargine in Hospitalized Patients with Type 2 Diabetes: A Randomized Crossover Trial. Adv Ther. 2016; 33(2):178-85. DOI: 10.1007/s12325-016-0288-7. View

Heller S, Koenen C, Bode B . Comparison of insulin detemir and insulin glargine in a basal-bolus regimen, with insulin aspart as the mealtime insulin, in patients with type 1 diabetes: a 52-week, multinational, randomized, open-label, parallel-group, treat-to-target.... Clin Ther. 2009; 31(10):2086-97. DOI: 10.1016/j.clinthera.2009.10.006. View

Klein O, Lynge J, Endahl L, Damholt B, Nosek L, Heise T . 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; 9(3):290-9. DOI: 10.1111/j.1463-1326.2006.00685.x. View

. 14. Diabetes Care in the Hospital: . Diabetes Care. 2017; 41(Suppl 1):S144-S151. DOI: 10.2337/dc18-S014. View

Hollander P, Cooper J, Bregnhoj J, Pedersen C . A 52-week, multinational, open-label, parallel-group, noninferiority, treat-to-target trial comparing insulin detemir with insulin glargine in a basal-bolus regimen with mealtime insulin aspart in patients with type 2 diabetes. Clin Ther. 2008; 30(11):1976-87. DOI: 10.1016/j.clinthera.2008.11.001. View

Wallace J, Wallace J, McFarland M . Comparing dosing of basal insulin analogues detemir and glargine: is it really unit-per-unit and dose-per-dose?. Ann Pharmacother. 2014; 48(3):361-8. DOI: 10.1177/1060028013518420. View

10.

Porcellati F, Rossetti P, Busciantella N, Marzotti S, Lucidi P, Luzio S . Comparison of pharmacokinetics and dynamics of the long-acting insulin analogs glargine and detemir at steady state in type 1 diabetes: a double-blind, randomized, crossover study. Diabetes Care. 2007; 30(10):2447-52. DOI: 10.2337/dc07-0002. View

11.

Havelund S, Plum A, Ribel U, Jonassen I, Volund A, Markussen J . The mechanism of protraction of insulin detemir, a long-acting, acylated analog of human insulin. Pharm Res. 2004; 21(8):1498-504. DOI: 10.1023/b:pham.0000036926.54824.37. View

12.

Umpierrez G, Smiley D, Jacobs S, Peng L, Temponi A, Mulligan P . Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diabetes Care. 2011; 34(2):256-61. PMC: 3024330. DOI: 10.2337/dc10-1407. View

13.

Pieber T, Treichel H, Hompesch B, Philotheou A, Mordhorst L, Gall M . Comparison of insulin detemir and insulin glargine in subjects with Type 1 diabetes using intensive insulin therapy. Diabet Med. 2007; 24(6):635-42. DOI: 10.1111/j.1464-5491.2007.02113.x. View

14.

Bolli G, Owens D . Insulin glargine. Lancet. 2000; 356(9228):443-5. DOI: 10.1016/S0140-6736(00)02546-0. View

15.

Bryant G, McDanel D, Horner K, Farris K, Newkirk E . Evaluation of dosing and clinical outcomes in patients undergoing conversion of insulin glargine to insulin detemir. Pharmacotherapy. 2013; 33(1):56-62. DOI: 10.1002/phar.1168. View

16.

Plank J, Bodenlenz M, Sinner F, Magnes C, Gorzer E, Regittnig W . A double-blind, randomized, dose-response study investigating the pharmacodynamic and pharmacokinetic properties of the long-acting insulin analog detemir. Diabetes Care. 2005; 28(5):1107-12. DOI: 10.2337/diacare.28.5.1107. View

17.

Galindo R, Davis G, Fayfman M, Reyes-Umpierrez D, Alfa D, Peng L . COMPARISON OF EFFICACY AND SAFETY OF GLARGINE AND DETEMIR INSULIN IN THE MANAGEMENT OF INPATIENT HYPERGLYCEMIA AND DIABETES. Endocr Pract. 2017; 23(9):1059-1066. PMC: 6052791. DOI: 10.4158/EP171804.OR. View

18.

Rosenstock J, Davies M, Home P, Larsen J, Koenen C, Schernthaner G . A randomised, 52-week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetologia. 2008; 51(3):408-16. PMC: 2235909. DOI: 10.1007/s00125-007-0911-x. View

19.

Dungan K, Braithwaite S, Preiser J . Stress hyperglycaemia. Lancet. 2009; 373(9677):1798-807. PMC: 3144755. DOI: 10.1016/S0140-6736(09)60553-5. View

20.

Swinnen S, Simon A, Holleman F, Hoekstra J, DeVries J . Insulin detemir versus insulin glargine for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2011; (7):CD006383. PMC: 6486036. DOI: 10.1002/14651858.CD006383.pub2. View