A Comparison Between Glargine and Detemir Insulin in Type 2 Diabetes

Todate, most studies have compared insulin detemir and glargine to NPH and not to each other. Depending of their design, these studies have shown both insulins lower the fasting glucose, A1c, the incidence of hypoglycemia and are associated with less weight gain than NPH. In the only direct comparison study of these two basal insulins, insulin detemir demonstrated significantly less day to day variation than glargine as measured by glucose infusion rated during an euglycemic clamp study. Given the same incidence of hypoglycemia, this last study would suggest that insulin detemir treatment could achieve target glucose control more than glargine. We have used continuous glucose monitoring (CGMS) extensively in our practice. CGMS is arguably the most sensitive method for detecting differences in glycemic control in the outpatient setting and there by allowing fine adjustments in insulin treatment. When comparing insulin glargine to preprogrammable basal insulin as delivered by continuous subcutaneous infusion and using CGMS, we have shown significantly better glucose control with continuous subcutaneous infusion, We have also developed a method of daily insulin dosage adjustments during a continuous CGMS study from daily glucose tracings downloaded. This allows for an even more accurate basal insulin replacement per set glycemic goal. This protocol addresses a comparison of insulin glargine and insulin detemir for patients evaluated by CGMS.

Inclusion criteria

• Type 2 Diabetes
• Currently on a basal insulin, that is, NPH, glargine or detemir
• Capable of self monitoring glucose >4/day
• Previously complaint with clinical recommendations
• Subject may be on oral antiglycemic medications but no change in treatment is permitted during study.

Exclusion criteria

• Hb A1c >9.0%
• Urinary ketosis
• Currently or expected alteration in insulin sensitivity such as major surgery, infection, renal failure (creatine >1.5 mg/dL) glucocorticoid treatment, recent (within 2 weeks) serious hypoglycaemic episode (requires assistance of another)
• Currently participating in another clinical trial
• Known or suspected allergy to insulin glargine or detemir
• Using other insulins, such as, bolus insulin or premixed insulin
• Sight or hearing impaired
• Pregnancy oor nursing of the intention of becoming pregnant or not using adequate contraceptive measures.