Clinical Sciences Department, Drake University College of Pharmacy and Health Sciences, and Penn Avenue Internal Medicine, Des Moines, Iowa 50311, USA.
Pharmacotherapy. 2013 Jan;33(1):56-62. doi: 10.1002/phar.1168.
To evaluate the dose and frequency of insulin detemir for patients with diabetes mellitus undergoing conversion from insulin glargine to insulin detemir, and to assess glycemic control, weight gain, and risk of hypoglycemia after converting to insulin detemir.
Retrospective medical record review.
Large academic medical center.
Thirty-one patients with type 1 (10 patients) or type 2 (21 patients) diabetes who were converted from insulin glargine to insulin detemir by usual practice between January 1, 2006, and March 3, 2007, after an Iowa Medicaid formulary switch.
Data were collected for 12 months after conversion from insulin glargine to insulin detemir. No significant change in mean basal insulin dose was noted in patients with type 1 diabetes at the end of 12 months (insulin detemir 31.1 units/day vs baseline insulin glargine 32.0 units/day, p=0.89; insulin detemir 0.41 unit/kg/day vs baseline insulin glargine 0.42 unit/kg/day, p=0.91). In patients with type 2 diabetes, however, the mean basal insulin dose was significantly higher with insulin detemir compared with baseline insulin glargine (74.2 vs 55.8 units/day, p=0.002; 0.68 vs 0.48 unit/kg/day, p=0.001) at the end of 12 months. Twice-daily administration was required in a higher proportion of patients receiving insulin detemir (15 patients [48%]) at 12 months compared with insulin glargine (4 patients [13%]) at baseline (p=0.043). A significant change in hemoglobin A(1c) was not observed in patients with type 1 diabetes (9.7% with insulin detemir vs 9.3% with insulin glargine, p=0.41) or type 2 diabetes (9.4% with insulin detemir vs 9.7% with insulin glargine at baseline, p=0.57) despite the use of higher insulin detemir doses in patients with type 2 diabetes. No significant differences in weight or frequency of hypoglycemia were noted.
Treatment with insulin detemir appears to require more frequent administration and higher insulin doses compared with insulin glargine in patients with type 2 diabetes, with 33% higher doses, on average, observed in this study. These findings suggest that a unit-for-unit conversion from insulin glargine to insulin detemir, as suggested by the manufacturer of insulin detemir, may not be adequate in patients with type 2 diabetes.
评估糖尿病患者从甘精胰岛素转换为地特胰岛素时的胰岛素地特胰岛素剂量和频率，并评估转换为地特胰岛素后血糖控制、体重增加和低血糖风险。
回顾性病历审查。
大型学术医疗中心。
31 名 1 型（10 名患者）或 2 型（21 名患者）糖尿病患者，他们在 2006 年 1 月 1 日至 2007 年 3 月 3 日期间根据爱荷华州医疗补助计划的规定从甘精胰岛素转换为地特胰岛素。
从甘精胰岛素转换为地特胰岛素后 12 个月收集数据。在 12 个月结束时，1 型糖尿病患者的基础胰岛素剂量没有明显变化（地特胰岛素 31.1 单位/天 vs 甘精胰岛素 32.0 单位/天，p=0.89；地特胰岛素 0.41 单位/公斤/天 vs 甘精胰岛素 0.42 单位/公斤/天，p=0.91）。然而，在 2 型糖尿病患者中，与基线甘精胰岛素相比，地特胰岛素的基础胰岛素剂量明显更高（74.2 与 55.8 单位/天，p=0.002；0.68 与 0.48 单位/公斤/天，p=0.001）在 12 个月结束时。与基线甘精胰岛素相比（15 名患者[48%]），在 12 个月时接受地特胰岛素治疗的患者需要更频繁的两次/天给药（4 名患者[13%]）（p=0.043）。尽管在 2 型糖尿病患者中使用了更高剂量的地特胰岛素，但 1 型糖尿病患者（地特胰岛素 9.7%与甘精胰岛素 9.3%，p=0.41）或 2 型糖尿病患者（地特胰岛素 9.4%与基线甘精胰岛素 9.7%，p=0.57）的血红蛋白 A1c 没有明显变化。体重或低血糖的频率没有明显差异。
与甘精胰岛素相比，地特胰岛素似乎需要更频繁的给药和更高的剂量，在这项研究中，平均观察到 33%的剂量增加。这些发现表明，制造商建议的从甘精胰岛素到地特胰岛素的单位转换，可能不足以用于 2 型糖尿病患者。
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