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Changing basal insulin from NPH to detemir or glargine in patients with type 1 diabetes and a history of severe hypoglycemia.
Vasc Health Risk Manag. 2009; 5(1):121-8.VH

Abstract

BACKGROUND

The insulin analogs, glargine and detemir, are associated with reduced hypoglycemia incidence compared with NPH insulin. We assessed the impact of changing basal insulin from NPH to glargine or detemir in patients with type 1 diabetes mellitus who experienced severe hypoglycemia.

MATERIAL AND METHODS

A retrospective chart review was conducted that included 73 (31 female) patients (mean age 48 years, diabetes duration 19 years) treated for 12 to 24 months with insulin glargine (n = 43) or detemir (n = 30).

RESULTS

There were no patients who withdrew from treatment due to side effects. The mean treatment duration in both groups was 18 months. Changing from NPH insulin was associated with a -0.3% (p = 0.036) reduction in HbA1c for glargine (baseline 8.8%) and -0.4% (p = 0.040) for detemir (baseline 8.3%) treated patients; insulin dosages increased, respectively by 4.1 (p = 0.045) and 4.3 units (p = 0.004) (mean values). Weight did not increase significantly and the 1-year rate of serious hypoglycemia was 0.25/person/year.

CONCLUSION

Switching from NPH-insulin to insulin detemir or glargine in type 1 diabetes mellitus patients with previous serious hypoglycemia was associated with a reduction in HbA1c. However, severe hypoglycemia was not completely eliminated, and few patients reached internationally accepted glycemic treatment goals.

LITERATURE SEARCH

We searched Medline, PubMed (with key search terms type 1 diabetes, NPH insulin, detemir, glargine and serious hypoglycemia), reference lists and databases of ongoing and completed trials (through July 2008) provided from the manufacturers of the drugs to identify relevant literature.

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Authors+Show Affiliations

Johansen OE
Medical Department, Asker and Baerum Hospital, RUD, Norway. odd.erik.johansen@broadpark.no
Vanberg PJ
No affiliation info available
Kilhovd BK
No affiliation info available
Jørgensen AP
No affiliation info available

MeSH

AdultAgedBlood GlucoseDiabetes Mellitus, Type 1Drug Administration ScheduleFemaleGlycated Hemoglobin AHumansHypoglycemiaHypoglycemic AgentsInsulinInsulin DetemirInsulin GlargineInsulin, IsophaneInsulin, Long-ActingMaleMiddle AgedRetrospective StudiesSeverity of Illness IndexTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19436668

Citation

Johansen, Odd Erik, et al. "Changing Basal Insulin From NPH to Detemir or Glargine in Patients With Type 1 Diabetes and a History of Severe Hypoglycemia." Vascular Health and Risk Management, vol. 5, no. 1, 2009, pp. 121-8.
Johansen OE, Vanberg PJ, Kilhovd BK, et al. Changing basal insulin from NPH to detemir or glargine in patients with type 1 diabetes and a history of severe hypoglycemia. Vasc Health Risk Manag. 2009;5(1):121-8.
Johansen, O. E., Vanberg, P. J., Kilhovd, B. K., & Jørgensen, A. P. (2009). Changing basal insulin from NPH to detemir or glargine in patients with type 1 diabetes and a history of severe hypoglycemia. Vascular Health and Risk Management, 5(1), 121-8.
Johansen OE, et al. Changing Basal Insulin From NPH to Detemir or Glargine in Patients With Type 1 Diabetes and a History of Severe Hypoglycemia. Vasc Health Risk Manag. 2009;5(1):121-8. PubMed PMID: 19436668.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Changing basal insulin from NPH to detemir or glargine in patients with type 1 diabetes and a history of severe hypoglycemia. AU - Johansen,Odd Erik, AU - Vanberg,Pål Johan, AU - Kilhovd,Bente Kvarv, AU - Jørgensen,Anders Palmstrøm, Y1 - 2009/04/08/ PY - 2009/5/14/entrez PY - 2009/5/14/pubmed PY - 2009/6/20/medline KW - HbA1c KW - efficacy KW - insulin KW - observational study KW - type 1 diabetes mellitus SP - 121 EP - 8 JF - Vascular health and risk management JO - Vasc Health Risk Manag VL - 5 IS - 1 N2 - BACKGROUND: The insulin analogs, glargine and detemir, are associated with reduced hypoglycemia incidence compared with NPH insulin. We assessed the impact of changing basal insulin from NPH to glargine or detemir in patients with type 1 diabetes mellitus who experienced severe hypoglycemia. MATERIAL AND METHODS: A retrospective chart review was conducted that included 73 (31 female) patients (mean age 48 years, diabetes duration 19 years) treated for 12 to 24 months with insulin glargine (n = 43) or detemir (n = 30). RESULTS: There were no patients who withdrew from treatment due to side effects. The mean treatment duration in both groups was 18 months. Changing from NPH insulin was associated with a -0.3% (p = 0.036) reduction in HbA1c for glargine (baseline 8.8%) and -0.4% (p = 0.040) for detemir (baseline 8.3%) treated patients; insulin dosages increased, respectively by 4.1 (p = 0.045) and 4.3 units (p = 0.004) (mean values). Weight did not increase significantly and the 1-year rate of serious hypoglycemia was 0.25/person/year. CONCLUSION: Switching from NPH-insulin to insulin detemir or glargine in type 1 diabetes mellitus patients with previous serious hypoglycemia was associated with a reduction in HbA1c. However, severe hypoglycemia was not completely eliminated, and few patients reached internationally accepted glycemic treatment goals. LITERATURE SEARCH: We searched Medline, PubMed (with key search terms type 1 diabetes, NPH insulin, detemir, glargine and serious hypoglycemia), reference lists and databases of ongoing and completed trials (through July 2008) provided from the manufacturers of the drugs to identify relevant literature. SN - 1178-2048 UR - https://www.unboundmedicine.com/medline/citation/19436668/Changing_basal_insulin_from_NPH_to_detemir_or_glargine_in_patients_with_type_1_diabetes_and_a_history_of_severe_hypoglycemia_ L2 - https://www.dovepress.com/articles.php?article_id=2741 DB - PRIME DP - Unbound Medicine ER -
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