WordNet

hormone secreted by the isles of Langerhans in the pancreas; regulates storage of glycogen in the liver and accelerates oxidation of sugar in cells

PrepTutorEJDIC

インシュリン(膵臓(すいぞう)ホルモンで糖尿病治療剤)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/12/18 01:06:09」(JST)

wiki en

Insulin detemir is a long-acting human insulin analogue for maintaining the basal level of insulin. Novo Nordisk markets it under the trade name Levemir. It is an insulin analogue in which a fatty acid (myristic acid) is bound to the lysine amino acid at position B29. It is quickly absorbed after which it binds to albumin in the blood through its fatty acid at position B29. It then slowly dissociates from this complex.

In a clinical study^[1] that compared the efficacy and safety of using Levemir for the treatment of patients with type 2 diabetes who had suboptimal glycemic control while receiving maximally tolerated doses of metformin and sulfonylurea (common tablet therapies for type 2 diabetes), it was found that, "At 24 weeks, HbA_1c (glycosylated hemoglobin) had decreased by 1.8 and 1.9% (from 8.6 to 6.8 and from 8.5 to 6.6%) for detemir and NPH, respectively (NS). In both groups, 70% of participants achieved an HbA_1c of 7.0%, but the proportion achieving this without hypoglycemia was higher with insulin detemir than with NPH insulin (26 vs. 16%, P = 0.008). Compared with NPH insulin, the risk for all hypoglycemia with insulin detemir was reduced by 47% (P < 0.001) and nocturnal hypoglycemia by 55% (P < 0.001). Mean weight gain was 1.2 kg with insulin detemir and 2.8 kg with NPH insulin (P < 0.001), and the difference in baseline-adjusted final weight was –1.58 (P < 0.001)."

In short, it was found that insulin detemir reduced HbA_1c to target levels of 7.0% for 70% of patients, similar to human basal insulin, NPH, but without the same risk of hypoglycemia and with somewhat less weight gain.

Regarding weight gain compared to NPH insulin, the Levemir package insert states the following disclaimer:

"LEVEMIR was associated with somewhat less weight gain than NPH (Table 4). Whether these observed differences represent true differences in the effects of LEVEMIR and NPH insulin is not known, since these trials were not blinded and the protocols (e.g., diet and exercise instructions and monitoring) were not specifically directed at exploring hypotheses related to weight effects of the treatments compared. The clinical significance of the observed differences has not been established..."Levemir Package Insert; Adverse Reactions > Weight Gain

In addition, the safety and efficacy of insulin detemir (Levemir®) in real life clinical practice was evaluated in the A1chieve study.

On June 13, 2009, the U.S. Food and Drug Administration (FDA) issued a public health advisory for Levemir insulin after learning that 129,000 stolen vials reappeared and were being sold in the U.S. market. The FDA warned that the stolen vials "may not have been stored and handled properly and may be dangerous for patients to use." The stolen vials were identified as lots XZF0036, XZF0037, and XZF0038.

References

^ http://care.diabetesjournals.org/cgi/content/abstract/29/6/1269?ijkey=2e8d412f27ded6ae0a205b3bfd4d3608ed9b64b5&keytype2=tf_ipsecsha , A 26-Week, Randomized, Parallel, Treat-to-Target Trial Comparing Insulin Detemir With NPH Insulin as Add-On Therapy to Oral Glucose-Lowering Drugs in Insulin-Naïve People With Type 2 Diabetes, Kjeld Hermansen, MD1, Melanie Davies, MD2, Taudeusz Derezinski, MD3, Gabrielle Martinez Ravn4, Per Clauson4, Philip Home, DM, DPHIL5 on behalf of the Levemir Treat-to-Target Study Group

1. http://content.nejm.org/cgi/content/full/NEJMoa075392, Addition of Biphasic, Prandial, or Basal Insulin to Oral Therapy in Type 2 Diabetes; Rury R. Holman, M.B., Ch.B., F.R.C.P., Kerensa I. Thorne, M.Sc., Andrew J. Farmer, D.M., F.R.C.G.P., Melanie J. Davies, M.D., F.R.C.P., Joanne F. Keenan, B.A., Sanjoy Paul, Ph.D., Jonathan C. Levy, M.D., F.R.C.P., for the 4-T Study Group

2. http://www.springerlink.com/content/6lktug1r2exurq0j/?p=af5e2f613a0f4c6690f8fdc920f48bd6&pi=5, Insulin analogues (insulin detemir and insulin aspart) versus traditional human insulins (NPH insulin and regular human insulin) in basal-bolus therapy for patients with Type 1 diabetes, Journal Diabetologia, volume 47, number 4 / April, 2004.

External links

Levemir US website
[1] Levemir Package Insert
A1chieve study in insulin a 60 000-person, global, prospective, observational study of basal, meal-time, and biphasic insulin analogs in daily clinical practice

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. Insulin: Drug formulations
2. 2型糖尿病におけるインスリン療法 insulin therapy in type 2 diabetes mellitus
3. 糖尿病におけるインスリン療法の一般原則 general principles of insulin therapy in diabetes mellitus
4. 成人の1型糖尿病における血糖値マネージメント management of blood glucose in adults with type 1 diabetes mellitus
5. 糖尿病に対するインスリン療法に関する問題についての症例 cases illustrating problems with insulin therapy for diabetes mellitus

English Journal

Systematic review and meta-analysis of randomized clinical trials comparing efficacy and safety outcomes of insulin glargine with NPH insulin, premixed insulin preparations or with insulin detemir in type 2 diabetes mellitus.

Rys P1, Wojciechowski P, Rogoz-Sitek A, Niesyczyński G, Lis J, Syta A, Malecki MT.
Acta diabetologica.Acta Diabetol.2015 Aug;52(4):649-62. doi: 10.1007/s00592-014-0698-4. Epub 2015 Jan 14.
AIMS: A variety of basal insulin preparations are used to treat patients with type 2 diabetes mellitus (T2DM). We aimed to summarize scientific evidence on relative efficacy and safety of insulin glargine (IGlar) and other insulins in T2DM.METHODS: A systematic review was carried out in major medica
PMID 25585592

Higher insulin detemir doses are required for the similar glycemic control: comparison of insulin detemir and glargine in children with type 1 diabetes mellitus.

Abalı S1, Turan S1, Atay Z1, Güran T1, Haliloğlu B1, Bereket A1.
Pediatric diabetes.Pediatr Diabetes.2015 Aug;16(5):361-6. doi: 10.1111/pedi.12167. Epub 2014 Jul 11.
OBJECTIVE: We aimed to compare hemoglobin A1c (HbA1c), total and basal insulin doses, basal insulin injection frequencies, and body mass index (BMI) in children with type 1 diabetes mellitus (T1DM) who are receiving detemir and glargine as basal insulin in a basal-bolus therapy.METHOD: This retrospe
PMID 25039448

Severe hypoglycaemia in adults with insulin-treated diabetes: impact on healthcare resources.

Heller SR1, Frier BM2, Hersløv ML3, Gundgaard J4, Gough SC5.
Diabetic medicine : a journal of the British Diabetic Association.Diabet Med.2015 Jul 16. doi: 10.1111/dme.12844. [Epub ahead of print]
AIMS: To assess resource utilization associated with severe hypoglycaemia across three insulin regimens in a large phase 3a clinical programme involving people with Type 1 diabetes treated with basal-bolus insulin, people with Type 2 diabetes treated with multiple daily injections and people with
PMID 26179360

Japanese Journal

症例インスリンデテミル(レベミル)およびインスリングラルギン(ランタス)注射部位に浸潤性紅斑を呈した1例

西日本皮膚科 = The Nishinihon journal of dermatology : 日本皮膚科学会西部支部機関誌 78(1), 54-56, 2016-02
NAID 40020758085

持効型インスリン (特集糖尿病治療薬update : 適正な血糖管理を目指して) -- (糖尿病治療薬の薬効と適応基準)

日本臨床 73(3), 458-464, 2015-03
NAID 40020367208

An Open-label Longitudinal Study on the Efficacy of Switching from Insulin Glargine or Detemir to Degludec in Type 2 Diabetes Mellitus

Internal Medicine 54(13), 1591-1598, 2015
NAID 130005086447

Related Pictures

★リンクテーブル★

リンク元	「インスリンデテミル」「インスリンデテミール」

「インスリンデテミル」

Insulin Detemir
Clinical data
Trade names	Levemir
AHFS/Drugs.com	monograph
MedlinePlus	a606012
Pregnancy; category	US: B (No risk in non-human studies); ;
Legal status	US: ℞-only;
Routes of; administration	Subcutaneous
Pharmacokinetic data
Bioavailability	60% (when administered s.c.)
Biological half-life	5–7 hours
Identifiers
CAS Number	169148-63-4
ATC code	A10AE05
DrugBank	DB01307
UNII	4FT78T86XV
KEGG	D04539
Chemical data
Formula	C267H402N64O76S6
Molecular mass	5913 g/mol
(what is this?) (verify)