title: Two-way crossover comparison of insulin glargine and insulin detemir in basal-bolus therapy using continuous glucose monitoring.
abstract: OBJECTIVE
  This study aimed to compare the glucose-lowering effect and glycemic variability of insulin glargine with those of insulin detemir.
  
  
  METHODS
  This was an open-label, single-center, randomized, two-way crossover study in patients with diabetes on basal-bolus insulin therapy, with neutral protamine Hagedorn (NPH) insulin as basal insulin. Patients switched from NPH insulin to a course either of insulin glargine followed by insulin detemir, or insulin detemir followed by insulin glargine, continuing the same dose of the prior bolus of insulin. To evaluate the glucose-lowering effect, daily glycemic profiles were recorded for 72 hours by continuous glucose monitoring (CGM) in an outpatient setting. The mean amplitude of glycemic excursions, standard deviation (SD), and the mean of daily difference (MODD) were used to assess intraday and day-to-day glycemic variability.
  
  
  RESULTS
  Eleven patients were enrolled and nine completed the study. Mean blood glucose calculated from CGM values was significantly lower with insulin glargine compared with insulin detemir (9.6 ± 2.4 mmol/L versus 10.4 ± 2.8 mmol/L, P = 0.038). The SD was significantly lower with insulin glargine versus insulin detemir (2.5 ± 0.9 mmol/L vs 3.5 ± 1.6 mmol/L, P = 0.011). The MODD value was significantly lower with insulin glargine than with insulin detemir (2.2 ± 1.1 mmol/L vs 3.6 ± 1.7 mmol/L, P = 0.011). There was no significant difference between the two insulin analogs in terms of hypoglycemia.
  
  
  CONCLUSIONS
  This study suggests that insulin glargine leads to more effective and more stable glycemic control than the same dose of insulin detemir.
authors.affiliation: Diabetes Center, Kitasato Institute Hospital.
authors.forename: Shinya
authors.initials: S
authors.lastname: Abe
authors.forename: Gaku
authors.initials: G
authors.lastname: Inoue
authors.forename: Satoru
authors.initials: S
authors.lastname: Yamada
authors.forename: Junichiro
authors.initials: J
authors.lastname: Irie
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nojima
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tsuyusaki
authors.forename: Kensuke
authors.initials: K
authors.lastname: Usui
authors.forename: Koichiro
authors.initials: K
authors.lastname: Atsuda
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Yamanouchi