Author:

Abstract:

The ultimate therapeutic aim for patients with type I and II diabetes is to attain normoglycaemia with the goal of preventing the onset or worsening of long-term complications. Current intensive insulin regimens attempt to achieve a 24-h normoglycaemia by substituting insulin activity as close as possible to the fysiological insulin secretion. However proper glycaemic control is limited by the risk of hypoglycaemia inherent to insulin therapy, especially when intensified. The traditional basal insulins display two limitations: the high within-subject variability and the peakactivity of the pharmocokinetic and pharmocodynamic profile. Insulin detemir, a new basal insulin analogue, reveals a unique protraction mechanism and a more predictable and stable action. Injected as a suspension its depot is only slowly absorbed from the subcutaneous tissues, while exerting a prolonged metabolic action. The mechanism underlying the protracted action is its self-association and albumin binding capaity in the subcutaneous depot and the circulation. When compared with NPH insulin, insulin detemir manifests a longer metabolic action and a significantly lower variability. In comparative trials with NPH insulin, and at better or equivalent levels of glycaemic control, insulin detemir has demonstrated a lower risk of hypoglycaemia, especially nocturnal hypoglycaemia. Furthermore a reduction of the fasting blood glycaemia was observed with less variation. In all clinical studies a significantly lowered weight gain was a consistant finding. All effects were maximal when insulin detemir was combined in a basal-bolus regimen with fast acting insulin analogues.