Insulin detemir: a better basal insulin for the management of diabetes?

Abstract

The prevalence of diabetes mellitus continues to grow. The current number of people in the USA diagnosed with diabetes has reached 17.5 million and, in 2007, the cost of the disease reached US$174 billion. The common feature of diabetes is the relative lack of insulin. This defect appears to worsen over the lifetime of the individual, necessitating the introduction of insulin therapy in most affected individuals. Of the various choices, basal insulin is commonly initiated as the first insulin. There are three choices for basal insulin; two insulin analogs (insulin glargine and insulin detemir) and neutral protamine Hagedorn (NPH) insulin. Although NPH is inexpensive, its use is fraught with unpredictability and, in some cases, an insufficient duration of action. Both insulin analogs have an advantage over NPH by possessing a longer duration and fewer complications of hypoglycemia. Compared with insulin glargine, detemir may have a greater advantage owing to lower within-patient variability of action, incidence of hypoglycemia and weight gain.