Insulin Detemir Compared to Insulin Glargine: Appetite and Calories Consumed in Type 1 Diabetes

Insulin detemir is a neutral, soluble long acting insulin analog with weight neutral properties. In limited studies, it has been shown to result in less weight gain in type 1 and type 2 diabetics compared with other long acting insulin formations. A possible mechanism for its weight neutrality is the fatty acid chain that may allow for improved central nervous system activity and effects on satiety. The primary objective of this study is to determine if patients with type 1 diabetes consume fewer calories when allowed to eat to satiety while treated with insulin detemir compared to insulin glargine. Secondary objectives are 1) subject responses on validated satiety scales and food diaries, 2) bioelectrical impedance analysis, 3) resting energy expenditure on indirect calorimetry/metabolic cart measurement, and 4) centrally acting mediators of satiety measured in the serum (Peptide YY [PYY], ghrelin, leptin).

Inclusion criteria

• Type 1 diabetes
• Treated with long-acting and meal time insulin therapy for at least 2 years
• Ages 18 to 60 years of age
• Glycosylated hemoglobin value between 7 - 9 mg/dL
• C-peptide value less than 1.0 pmol/ml 90 minutes after oral Boost Plus administration.

Exclusion criteria

• Advanced complications of diabetes (nephropathy, retinopathy, significant neuropathy, coronary artery disease)
• Severe medical illness or medical conditions including congestive heart failure, angina, liver failure or renal failure
• Pregnancy
• Alcohol or drug abuse or dependence within three months of study entry
• Less than 50 % agreement on 50-item Food Questionnaire with the Food Array "buffet style" study meal.
• Women of child-bearing age not adhering to the following contraceptive methods: oral contraceptives, barrier methods including condoms or diaphragm, or abstinence.