Professional Documents
Culture Documents
Outlines
Prevalence
Current management
Rationale for early initiation
Insulin guideline
Insulin detemir profile
Glycaemic control, weight benefit, hypoglycaemia using insulin
detemir
Insulin detemir in special population
Summary
ESW/MAR-17/RTD LVM-2017/001
China 96,2
India 66,8
USA 25,7
Brazil 11,6
Indonesia 9,1 5
Mexico 9
7 Egypt 7,5
German 7,2
7
Turkey 7,2
Japan 7,2
Sources :
1. IDF Diabetes Atlas, 6th ed
2. IDF Diabetes Atlas 6th ed UPDATE
3. IDF Diabetes Atlas, 7th ed
ESW/MAR-17/RTD LVM-2017/001
Outlines
Prevalence
Current management
Rationale for early initiation
Insulin guideline
Insulin detemir profile
Glycaemic control, weight benefit, hypoglycaemia using insulin
detemir
Insulin detemir in special population
Summary
ESW/MAR-17/RTD LVM-2017/001
()
Insulin
secretion
Metformin (+)
Insulin
(+)
Sulphonylureas
Meglitinides
GLP-1 analogues
DPP-4 inhibitors
ESW/MAR-17/RTD LVM-2017/001
Outlines
Prevalence
Current management
Rationale for early initiation
Insulin guideline
Insulin detemir profile
Glycaemic control, weight benefit, hypoglycaemia using insulin
detemir
Insulin detemir in special population
Summary
ESW/MAR-17/RTD LVM-2017/001
Lebovitz. Diabetes Reviews 1999;7:13953 (data are from the UKPDS population: UKPDS 16.
Diabetes 1995;44:124958)
SOLVE: HbA1c at time of insulin initiation
Baseline HbA1c at time of
insulin initiation
10.0 9,8 9,8 The average HbA1c was 8.9%
9.5 9,4 Prior to insulin initiation, patients
9,2 9,1 had received OAD therapy for
8,9 8,9 8.76.7 years
HbA1c (%)
9.0
8,5 8,4 Patients remain poorly controlled
8.5 8,3 on OAD treatment for prolonged
periods of time
8.0
7.5
10.0 +0.2%
0.5%*
1.0%*
9.0 Pre-treatment
Mean HbA1c (%)
Post-treatment
8.0
7.0
6.0
Two OADs Three OADs Four OADs Insulin
*p<0.001
Calvert et al. Br J Gen Pract 2007;57:45560
ESW/MAR-17/RTD LVM-2017/001
Outlines
Prevalence
Current management
Rationale for early initiation
Insulin guideline
Insulin detemir profile
Glycaemic control, weight benefit, hypoglycaemia using insulin
detemir
Insulin detemir in special population
Summary
ESW/MAR-17/RTD LVM-2017/001
Outlines
Prevalence
Current management
Rationale for early initiation
Insulin guideline
Insulin detemir profile
Glycaemic control, weight benefit, hypoglycaemia using insulin
detemir
Insulin detemir in special population
Summary
ESW/MAR-17/RTD LVM-2017/001
Levemir
LysB29(N-tetradecanoyl)des(B30) human insulin
Minor protraction
Circulation
Albumin binding
Insulin detemir
0.4 U/kg 0.8 U/kg 1.4 U/kg
Insulin glargine
3.0
No
Glucose infusion
(mg/kg/min)
2.5 significant
2.0 between-
rate
1.5 treatment
difference at
1.0
each dose
0.5 level
0
0 2 4 6 8 10 12 14 16 18 20 22 24
Time from insulin injection (hours)
12
Time of day
24-h glucose profiles. Each point represents the treatment groups mean glucose for each hour and standard error of 29 subjects treated with
once-daily insulin detemir or glargine starting at 20:00 hours. The basal period is from 24:00 hours to 06:00 hours.
18
Adapted from Heise T et al. Diabetes. 2004;53:1614-20.
ESW/MAR-17/RTD LVM-2017/001
Outlines
Prevalence
Current management
Rationale for early initiation
Insulin guideline
Insulin detemir profile
Glycaemic control, weight benefit, hypoglycaemia using
insulin detemir
Insulin detemir in special population
Summary
ESW/MAR-17/RTD LVM-2017/001
Insulin glargine
8.0
7.5
7.0
6.5
10.0
9.5 Insulin glargine
9.0
8.5
8.0
7.5
7.0
6.5
6.0
1.3 NS
1.2 Insulin detemir
p<0.02 p=0.031 p<0.001 p<0.001 NS NS p<0.05
1.1
1.0
NPH insulin
0.9
Insulin glargine
Relative risk
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
Overall Nocturnal Overall Nocturnal Overall Nocturnal Overall Nocturnal
Philis-Tsimikas 2006 Hermansen 2006 Rosenstock 2008 Meneghini 2013
p<0.05
Insulin detemir
p<0.005 p<0.001 NS p<0.001
4.0
NPH insulin
3.5
Weight change (kg)
0.0 -80
Change from baseline to
-1.0
week 24
-100
-101*
-2.0
-2.2*
-115*
-3.0 -120
*p<0.001
Soewondo P, et al. Clinical experience with insulin detemir: Results from the Indonesian cohort of the international A1chieve study.
Diabetes Research and Clinical Practice 2013; 100(S1): S47S53
ESW/MAR-17/RTD LVM-2017/001
6.0
Percent with at least one event
5.10
5.0 4.80
4.0
3.0
2.0
1.0
0.30
0.00 0.00 0.00
0.0
Baseline Week 24 Baseline Week 24 Baseline Week 24
Soewondo P, et al. Clinical experience with insulin detemir: Results from the Indonesian cohort of the international A1chieve study.
Diabetes Research and Clinical Practice 2013; 100(S1): S47S53
ESW/MAR-17/RTD LVM-2017/001
Significant improvement
(p<0.001)
*p<0.001
Soewondo P, et al. Clinical experience with insulin detemir: Results from the Indonesian cohort of the international A1chieve study.
Diabetes Research and Clinical Practice 2013; 100(S1): S47S53
ESW/MAR-17/RTD LVM-2017/001
Outlines
Prevalence
Current management
Rationale for early initiation
Insulin guideline
Glycaemic control, weight benefit, hypoglycaemia using insulin
detemir
Insulin detemir in special population
Summary
ESW/MAR-17/RTD LVM-2017/001
Outlines
Prevalence
Current management
Rationale for early initiation
Insulin guideline
Insulin detemir profile
Glycaemic control, weight benefit, hypoglycaemia using insulin
detemir
Insulin detemir in special population
Summary
ESW/MAR-17/RTD LVM-2017/001
Summary
Insulin therapy is the most efficacious therapy and can reduce HbA1c up to
2,5%
Starting with basal insulin detemir 10 U once daily and titrate based on
patient condition to reach glycemic control