Replacement of neutral protamine Hagedorn insulin with the long-acting insulin analogue, detemir, improves glycemic control without weight gain in basal-bolus insulin therapy in Japanese patients with type 1 diabetes.
Aims/Introduction:  The aim of the present study was to evaluate the efficacy of replacing neutral protamine Hagedorn insulin (NPH) with the long-acting insulin analogue, detemir, in clinical practice.


METHODS
We carried out a retrospective study to compare the effects of replacing NPH with detemir in basal-bolus insulin therapy in Japanese patients with type 1 diabetes. A total of 19 patients were enrolled in the study, and changes in hemoglobin A1c (HbA1c), insulin dose, bodyweight, fasting blood glucose levels (FBG), within-patient variability in FBG and prevalence in hypoglycemia were monitored for 12 weeks before replacement and during three periods after replacement; 1-12 weeks (period 1), 13-24 weeks (period 2) and 25-36 weeks (period 3).


RESULTS
HbA1c values improved significantly in periods 2 and 3. Despite the total insulin dose remaining unchanged throughout the study, the basal insulin dose increased from 0.24 to 0.27 IU/kg/day in period 2 and 0.28 IU/kg/day in period 3. Bodyweight decreased from 61.8 to 60.8 kg in period 1, whereas FBG improved throughout the study. Within-patient variability in FBG was lower with detemir treatment than with NPH, despite the number of hypoglycemic episodes increasing significantly after replacement.


CONCLUSIONS
These findings show that the weight loss observed in patients was independent of the reduction in calorie intake resulting from less frequent hypoglycemic attacks. In Japanese patients with diabetes who received NPH, replacing NPH with detemir led to improvements in glycemic control without any weight gain. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2010.00066.x, 2010).
Departments of Pharmacy ; Department of Biopharmaceutics, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts, Kodo Kyotanabe, Kyoto, Japan.
Taro
T
Hayakawa
Internal Medicine, Otsu Municipal Hospital, Otsu, Shiga.
Michiyo
M
Ishii
Departments of Pharmacy.
Megumi
M
Watanabe
Internal Medicine, Otsu Municipal Hospital, Otsu, Shiga.
Hiroya
H
Iwase
Department of Biopharmaceutics, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts, Kodo Kyotanabe, Kyoto, Japan.
Asako
A
Nishimura
Departments of Pharmacy.
Takako
T
Monden
Internal Medicine, Otsu Municipal Hospital, Otsu, Shiga.
Kenji
K
Kamiuchi
Internal Medicine, Otsu Municipal Hospital, Otsu, Shiga.
Motohide
M
Isono
Department of Biopharmaceutics, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts, Kodo Kyotanabe, Kyoto, Japan.
Nobuhito
N
Shibata
Insulin detemir; Neutral protamine Hagedorn insulin; Replacement