New insulin helps control blood glucose levels

The recent approval of insulin detemir (Levemir) by the Food & Drug Administration rounds out the Novo Nordisk product line for diabetes. It also adds a new tool to help patients with diabetes achieve blood glucose targets and perhaps avoid gaining weight.

Alan Moses, M.D., associate VP, clinical research and medical affairs-endocrinology, Novo Nordisk, commented, "From a patient's perspective and a prescribing physician's perspective, we now have basically an insulin for every diabetes patient's need, whether it be for basal [insulin] only [in combination with oral agents], a premixed insulin [NovoLog Mix 70/30], or basal/bolus therapy [Levemir and NovoLog], as well as for the highest intensity NovoLog and pump therapy."

"Experts agree there is a need for consistent good control of patients' glucose levels, which is associated with a reduced risk of diabetes and complications," said Peter Aurup, M.D., VP of Novo Nordisk's clinical development, medical, and regulatory affairs department. "The results seen with Levemir affirm the value the product will provide to patients who struggle to manage their diabetes."

Package labeling states insulin detemir is indicated for once- or twice-daily subcutaneous dosing. Moses stated, "It will largely be up to the clinical response to determine whether going to twice-daily dosing is necessary. I think it is fair to say, a significant number of patients with Type 2 diabetes will do just fine with once-daily insulin detemir."

One intriguing finding about insulin detemir that surfaced in studies is its apparent effect on weight. Head-to-head trials between insulin detemir and NPH insulin for up to six months in patients with Type 1 and Type 2 diabetes found patients treated with insulin detemir experienced less weight gain. The package labeling, however, declined to definitively attribute this to insulin detemir.

Safety data also show that in trials of up to six months' duration in patients with Type 1 and Type 2 diabetes, the incidence of hypoglycemia in patients treated with insulin detemir was comparable to the incidence in patients treated with NPH insulin.

Although insulin detemir is likely to be used with other insulins, particularly in patients with Type 1 diabetes, Moses noted, "The label clearly reads that insulin detemir should not be mixed with other insulins." If insulin detemir is mixed with other insulin preparations, the profile of action of one or both individual components may change.

Moses commented that insulin detemir will be available in a FlexPen, "which is a great tool not only for the accuracy of administration but also in terms of the time it takes a patient to learn to administer insulin."