title: Comparing dosing of basal insulin analogues detemir and glargine: is it really unit-per-unit and dose-per-dose?
abstract: OBJECTIVE
  To review the available evidence regarding dosing conversion between glargine and detemir in an effort to assist clinicians in performing dosing conversion.
  
  
  METHODS
  A MEDLINE literature search was performed using the search terms glargine and detemir for articles published through August 2013.
  
  
  METHODS
  All English-language clinical trials were reviewed for inclusion of dosing and/or pharmacokinetic data.
  
  
  RESULTS
  A total of 7 large (n ≥ 258) randomized controlled trials (RCTs) comparing glargine and detemir in patients with type 1 and 2 diabetes had dosing equivalency data available. In these 7 RCTs, on average, a 38% higher detemir dose was required (range = 8.0%-77.2%) to achieve glucose control comparable to that achieved with glargine. A 24-hour isoglycemic clamp study conducted in 11 patients with type 1 diabetes demonstrated that the duration of action of detemir is dose dependent, with increasing doses of detemir resulting in increased duration of action of detemir. Pharmacokinetic studies conducted in patients with type 2 diabetes are conflicting, although the majority of evidence suggests that glargine provides a longer duration of glycemic control as compared with detemir.
  
  
  CONCLUSIONS
  When performing conversion between glargine and detemir, prescribers should be aware that higher doses of detemir as compared with glargine may be necessary to achieve the same glycemic control. Additionally, twice-daily injections of detemir should be considered in clinical situations in which glucose control appears to decline after 12 hours, especially with doses ≤0.4 units/kg/d in patients with type 1 diabetes.
authors.affiliation: Tennessee Valley Healthcare System, Nashville, TN, USA.
authors.forename: Juliet P
authors.initials: JP
authors.lastname: Wallace
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Wallace
authors.forename: M Shawn
authors.initials: MS
authors.lastname: McFarland
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000008:administration & dosage* / Q000493:pharmacokinetics
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting
keywords: adult medicine; ambulatory care; clinical decision making; clinical pharmacy; diabetes; dosing; insulin