Insulin detemir
| Clinical data | |
|---|---|
| Trade names | Levemir |
| AHFS/Drugs.com | Monograph |
| MedlinePlus | a606012 |
| Pregnancy category |
|
| Routes of administration |
Subcutaneous |
| ATC code | A10AE05 (WHO) |
| Legal status | |
| Legal status |
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| Pharmacokinetic data | |
| Bioavailability | 60% (when administered s.c.) |
| Biological half-life | 5–7 hours |
| Identifiers | |
| CAS Number |
169148-63-4 
|
| DrugBank |
DB01307 
|
| ChemSpider | none |
| UNII |
4FT78T86XV
|
| KEGG |
D04539
|
| Chemical and physical data | |
| Formula | C267H402N64O76S6 |
| Molar mass | 5913 g/mol |
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Insulin detemir is a long-acting human insulin analogue for maintaining the basal level of insulin. Novo Nordisk markets it under the trade name Levemir. It is an insulin analogue in which a fatty acid (myristic acid) is bound to the lysine amino acid at position B29. It is quickly absorbed after which it binds to albumin in the blood through its fatty acid at position B29. It then slowly dissociates from this complex.
In a clinical study that compared the efficacy and safety of using Levemir for the treatment of patients with type 2 diabetes who had suboptimal glycemic control while receiving maximally tolerated doses of metformin and sulfonylurea (common tablet therapies for type 2 diabetes), it was found that, "At 24 weeks, HbA1c (glycosylated hemoglobin) had decreased by 1.8 and 1.9% (from 8.6 to 6.8 and from 8.5 to 6.6%) for detemir and NPH, respectively (NS). In both groups, 70% of participants achieved an HbA1c of 7.0%, but the proportion achieving this without hypoglycemia was higher with insulin detemir than with NPH insulin (26 vs. 16%, P = 0.008). Compared with NPH insulin, the risk for all hypoglycemia with insulin detemir was reduced by 47% (P < 0.001) and nocturnal hypoglycemia by 55% (P < 0.001). Mean weight gain was 1.2 kg with insulin detemir and 2.8 kg with NPH insulin (P < 0.001), and the difference in baseline-adjusted final weight was –1.58 (P < 0.001)."
In short, it was found that insulin detemir reduced HbA1c to target levels of 7.0% for 70% of patients, similar to human basal insulin, NPH, but without the same risk of hypoglycemia and with somewhat less weight gain.
Regarding weight gain compared to NPH insulin, the Levemir package insert states the following disclaimer:
"LEVEMIR was associated with somewhat less weight gain than NPH (Table 4). Whether these observed differences represent true differences in the effects of LEVEMIR and NPH insulin is not known, since these trials were not blinded and the protocols (e.g., diet and exercise instructions and monitoring) were not specifically directed at exploring hypotheses related to weight effects of the treatments compared. The clinical significance of the observed differences has not been established..."Levemir Package Insert; Adverse Reactions > Weight Gain
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