Insulin detemir used in basal-bolus therapy in people with type 1 diabetes is associated with a lower risk of nocturnal hypoglycaemia and less weight gain over 12 months in comparison to NPH insulin

被引:134
作者
De Leeuw, I
Vague, P
Selam, JL
Skeie, S
Lang, H
Draeger, E
Elte, JWF
机构
[1] Univ Antwerp, B-2020 Antwerp, Belgium
[2] Hop La Timone, Marseille, France
[3] Hop Hotel Dieu, Paris, France
[4] Cent Hosp Rogaland, Stavanger, Norway
[5] Hjertelaget Res Fdn, Stavanger, Norway
[6] Novo Nordisk AS, DK-2880 Bagsvaerd, Denmark
[7] St Franciscus Gasthuis, Rotterdam, Netherlands
关键词
basal-bolus therapy; insulin detemir; nocturnal hypoglycaemia; NPH insulin; type; 1; diabetes;
D O I
10.1111/j.1463-1326.2004.00363.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aim: The aim of this study was to compare the long-term safety and efficacy of twice-daily insulin detemir or NPH insulin as the basal component of basal-bolus therapy in people with type 1 diabetes. Methods: A multicentre, open-label, parallel-group study was conducted over 12 months and completed by 308 people (from an original randomized cohort of 428). Patients were randomized in a 2 : 1 ratio to receive insulin detemir or NPH insulin before breakfast and dinner, with insulin aspart at mealtimes. Results: Glycaemic control improved in both groups with HbA(1c) decreasing by 0.64 and 0.56% point in the insulin detemir and NPH insulin groups, reaching baseline-adjusted final values of 7.53+/-0.10% and 7.59+/-0.13%, respectively. No significant difference was apparent between treatments in terms of HbA(1c), fasting plasma glucose or 9-point blood glucose profiles. Fewer hypoglycaemic events (major and minor) occurred in association with insulin detemir compared with NPH insulin, but the overall hypoglycaemic risk did not differ statistically significantly (RR for detemir, 0.78 [0.56-1.08]). However, the risk of nocturnal hypoglycaemia during the maintenance phase (month 2-12) was 32% lower in the detemir group (p=0.02) and lower in every month. This risk reduction remained statistically significant after correction for HbA(1c). After 12 months, baseline-adjusted mean body weight was significantly lower in the insulin detemir group than in the NPH insulin group (p<0.001). Conclusions: In long-term basal-bolus therapy, insulin detemir with insulin aspart as mealtime insulin is well tolerated and reduces the risks of nocturnal hypoglycaemia and weight gain compared to NPH insulin.
引用
收藏
页码:73 / 82
页数:10
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