Get Connected:

 

Patient Characteristics' Effect on the Conversion Between Basal Insulins

The characteristics of patients who require increases in their basal insulin dose were compared with those requiring no increase following conversion between basal insulin analogues.
Published Online: Feb 20,2017
Danielle W. Donaldson, PharmD; Beth Greck, PharmD, CDE, BCACP; Benjamin R. Michalove, PharmD; and Antoine Al-Achi, PhD, MPharm, MS, CT
ABSTRACT
Objectives: To examine predetermined characteristics of patients who require increases in basal insulin dose compared with those requiring no increase following conversion from insulin glargine to insulin detemir.
Study Design: This retrospective chart review of patients converted from insulin glargine to insulin detemir was conducted at a Veterans Affairs Medical Center. 
Methods: Characteristics of patients who required an increase in basal insulin dose were compared with patients who did not require an increase after the conversion. The following patient characteristics were evaluated: age, body mass index, and tobacco use, and diagnoses of heart failure, hypertension, hyperthyroidism, and hypothyroidism. 
Results: A total of 330 patients were included in this study, and these individuals were categorized into groups for comparison. Group 1 (n = 73) contained patients who did not require an increase in dose following conversion. Group 2 (n = 116) contained patients who required an increase in dose. The 2 groups (Group 1 vs Group 2) did not significantly differ in any of the characteristics studied (P >.05). The remaining patients (Group N; n = 141) did not meet criteria for Group 1 or Group 2. 
Conclusions: There were no statistically significant differences in the studied characteristics of patients who required an increase in basal insulin dose when compared with those of patients who did not require an increase in dose after conversion. Further studies are needed to discern the factors shared by a subset of patients who require an increase in basal insulin dose following conversion.

Am J Pharm Benefits. 2017;9(1):17-21.

Diabetes is a chronic, progressive disease that affects more than 21 million individuals in the United States alone.1 Several landmark trials have demonstrated the clinical benefits of tight glycemic control, which include reducing the incidence and delaying the progression of microvascular complications and macrovascular events, such as myocardial infarction, stroke, and cardiovascular death.2-8 Of the available glucose-lowering agents, insulin is established as the most effective for achieving maximum glycemic control. In fact, guidelines from both the American Association of Clinical Endocrinologists and the American Diabetes Association recommend insulin as first-line therapy, with or without other antidiabetic medications, for symptomatic patients with a markedly elevated glycated hemoglobin (A1C) value.5,7 According to the National Diabetes Statistics Report, almost 30% of patients with diagnosed diabetes use insulin therapy in the United States, and most patients with type 2 diabetes (T2D) will eventually require basal insulin to achieve or maintain their therapeutic target.1-3,8-11

There were 2 basal insulin analogues marketed in the United States at the time of this study: glargine (Lantus) and detemir (Levemir). Although there are no clinical differences in safety and efficacy between the 2, they are different chemical entities with different mechanisms of action.2,8,10,12,13 Insulin detemir contains an acylated fatty-acid chain that allows reversible binding with albumin, which provides slow absorption from the injection site and distribution to the target tissues, leading to a dose-dependent onset and duration of action. Insulin glargine forms micro-precipitates on injection, causing a slow release into the bloodstream.2,14,15 With these differences in action, it is plausible that the 2 may exhibit different pharmacokinetics and dynamics.10,13

Clinical trials comparing insulin detemir and insulin glargine in T2D have provided conflicting results in terms of dose, duration of action, and/or frequency of administration.2,8,10,12,14,16-24 Studies of the conversion from insulin glargine to insulin detemir report that some patients who are switched from insulin glargine to insulin detemir may require more frequent administration and higher insulin doses; however, these studies have not addressed the potential reasons why this may be the case.2,10,24




PDF
Most Popular