Critical appraisal of the safety and efficacy of insulin detemir in glycemic control and cardiovascular risk management in diabetics

Jean-Pierre Le FlochDepartment of Diabetology, Medical Clinic, Villecresnes, FranceAbstract: Insulin detemir is an analog of human insulin designed to provide a long duration of basal insulin action. This is achieved by protracted absorption from the injection depot, which results in part from incre...

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Autor principal:	Jean-Pierre Le Floch
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2010
Materias:	Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/49845e4bb4b946909a14f9b14a7a68a3
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spelling	oai:doaj.org-article:49845e4bb4b946909a14f9b14a7a68a32021-12-02T01:23:19ZCritical appraisal of the safety and efficacy of insulin detemir in glycemic control and cardiovascular risk management in diabetics1178-7007https://doaj.org/article/49845e4bb4b946909a14f9b14a7a68a32010-06-01T00:00:00Zhttp://www.dovepress.com/critical-appraisal-of-the-safety-and-efficacy-of-insulin-detemir-in-gl-a4626https://doaj.org/toc/1178-7007Jean-Pierre Le FlochDepartment of Diabetology, Medical Clinic, Villecresnes, FranceAbstract: Insulin detemir is an analog of human insulin designed to provide a long duration of basal insulin action. This is achieved by protracted absorption from the injection depot, which results in part from increased self-association of insulin detemir molecules and in part from reversible albumin binding. Subsequent albumin binding in the circulation is thought to buffer changes in the effects at target tissues that could otherwise arise from variability in absorption rate. In consequence, insulin detemir has shown a less variable pharmacodynamic profile than alternative basal insulins; this manifests as more consistent temporal glucose reduction profiles in repeat-clamp studies. In clinical trials, insulin detemir has been characterized by consistent risk reductions in hypoglycemia, as well as reduced weight gain in comparison with other basal insulins. Given some recent associations that have been made in prospective and epidemiologic studies between glucose variability and/or hypoglycemia and increased cardiovascular risk, and the long-known association between excess weight and cardiovascular risk, it is possible that the clinical profile of insulin detemir may carry prognostic value with regard to cardiovascular safety, although this is yet to be substantiated. There have also been some concerns raised recently over the use of insulin analogs and cancer risk, but available clinical data and the receptor interaction profile of insulin detemir suggest no excess in risk in comparison with human insulin therapy. Optimal approaches for the clinical use of insulin detemir have been emerging through an increasing clinical study base, and the analog is becoming established as a potentially valuable therapy option.Keywords: insulin detemir, type 2 diabetes, glucose variability, hypoglycemia, weight gain Jean-Pierre Le FlochDove Medical PressarticleSpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol 2010, Iss default, Pp 197-213 (2010)
institution	DOAJ
collection	DOAJ
language	EN
topic	Specialties of internal medicine RC581-951
spellingShingle	Specialties of internal medicine RC581-951 Jean-Pierre Le Floch Critical appraisal of the safety and efficacy of insulin detemir in glycemic control and cardiovascular risk management in diabetics
description	Jean-Pierre Le FlochDepartment of Diabetology, Medical Clinic, Villecresnes, FranceAbstract: Insulin detemir is an analog of human insulin designed to provide a long duration of basal insulin action. This is achieved by protracted absorption from the injection depot, which results in part from increased self-association of insulin detemir molecules and in part from reversible albumin binding. Subsequent albumin binding in the circulation is thought to buffer changes in the effects at target tissues that could otherwise arise from variability in absorption rate. In consequence, insulin detemir has shown a less variable pharmacodynamic profile than alternative basal insulins; this manifests as more consistent temporal glucose reduction profiles in repeat-clamp studies. In clinical trials, insulin detemir has been characterized by consistent risk reductions in hypoglycemia, as well as reduced weight gain in comparison with other basal insulins. Given some recent associations that have been made in prospective and epidemiologic studies between glucose variability and/or hypoglycemia and increased cardiovascular risk, and the long-known association between excess weight and cardiovascular risk, it is possible that the clinical profile of insulin detemir may carry prognostic value with regard to cardiovascular safety, although this is yet to be substantiated. There have also been some concerns raised recently over the use of insulin analogs and cancer risk, but available clinical data and the receptor interaction profile of insulin detemir suggest no excess in risk in comparison with human insulin therapy. Optimal approaches for the clinical use of insulin detemir have been emerging through an increasing clinical study base, and the analog is becoming established as a potentially valuable therapy option.Keywords: insulin detemir, type 2 diabetes, glucose variability, hypoglycemia, weight gain
format	article
author	Jean-Pierre Le Floch
author_facet	Jean-Pierre Le Floch
author_sort	Jean-Pierre Le Floch
title	Critical appraisal of the safety and efficacy of insulin detemir in glycemic control and cardiovascular risk management in diabetics
title_short	Critical appraisal of the safety and efficacy of insulin detemir in glycemic control and cardiovascular risk management in diabetics
title_full	Critical appraisal of the safety and efficacy of insulin detemir in glycemic control and cardiovascular risk management in diabetics
title_fullStr	Critical appraisal of the safety and efficacy of insulin detemir in glycemic control and cardiovascular risk management in diabetics
title_full_unstemmed	Critical appraisal of the safety and efficacy of insulin detemir in glycemic control and cardiovascular risk management in diabetics
title_sort	critical appraisal of the safety and efficacy of insulin detemir in glycemic control and cardiovascular risk management in diabetics
publisher	Dove Medical Press
publishDate	2010
url	https://doaj.org/article/49845e4bb4b946909a14f9b14a7a68a3
work_keys_str_mv	AT jeanpierrelefloch criticalappraisalofthesafetyandefficacyofinsulindetemiringlycemiccontrolandcardiovascularriskmanagementindiabetics
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Critical appraisal of the safety and efficacy of insulin detemir in glycemic control and cardiovascular risk management in diabetics

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