title: Effects of insulin detemir and NPH insulin on renal handling of sodium, fluid retention and weight in type 2 diabetic patients.
abstract: OBJECTIVE
  In type 2 diabetic patients, insulin detemir (B29Lys(ε-tetradecanoyl),desB30 human insulin) induces less weight gain than NPH insulin. Due to the proposed reduction of tubular action by insulin detemir, type 2 diabetic patients should have increased urinary sodium excretion, thereby reducing extracellular volume and body weight when changed from NPH insulin to insulin detemir.
  
  
  METHODS
  In a randomised, open-labelled, two-way crossover study of 24 patients with type 2 diabetes, patients were first treated with NPH insulin or insulin detemir for 8 weeks. Thereafter, they were changed to the other insulin for 8 weeks. In a third 1 week period, they were changed back to the first insulin.
  
  
  RESULTS
  At the end of 8 weeks, body weight was reduced by 0.8 ± 0.2 kg (mean ± SEM) on insulin detemir compared with NPH insulin (p < 0.01). After insulin detemir treatment, we also observed a significant reduction of lean body mass (0.8 ± 0.2 kg, p < 0.05) and a non-significant reduction of extracellular volume (0.8 ± 0.5 l/1.73 m², p = 0.14). The weight loss occurred after as early as 1 week (0.8 ± 0.2 kg, p < 0.001), with a simultaneous and transient increase of urinary sodium excretion (p = 0.07).
  
  
  CONCLUSIONS
  Insulin detemir induces significant and sustained weight loss, which is first observed at 1 week after changing from NPH insulin. The initial weight loss seems to be related to changes in fluid volume and may reflect changed insulin action in the kidneys.
authors: Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors: K V
authors: KV
authors: Hendriksen
authors: T
authors: T
authors: Jensen
authors: P
authors: P
authors: Oturai
authors: B
authors: B
authors: Feldt-Rasmussen
mesh_terms: D000368:Aged; D001823:Body Composition / Q000187:drug effects; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism / Q000652:urine; D045604:Extracellular Fluid / Q000187:drug effects; D018495:Fluid Shifts / Q000187:drug effects; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000069057:Insulin Detemir; D007336:Insulin, Isophane / Q000009:adverse effects* / Q000627:therapeutic use; D049528:Insulin, Long-Acting / Q000009:adverse effects* / Q000627:therapeutic use; D061386:Insulin, Regular, Human / Q000009:adverse effects* / Q000627:therapeutic use; D000068880:Isophane Insulin, Human; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010352:Patient Dropouts; D012964:Sodium / Q000378:metabolism / Q000652:urine*; D013997:Time Factors; D014882:Water-Electrolyte Balance / Q000187:drug effects*; D015431:Weight Loss / Q000187:drug effects*
chemical_list: D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D061386:Insulin, Regular, Human; D000068880:Isophane Insulin, Human; D000069057:Insulin Detemir; D007336:Insulin, Isophane; D012964:Sodium