"Art" of balance, easy to reduce blood sugar

*It is only for medical professionals to read for reference.
Balance multiple factors, comprehensively and effectively control sugar.
The current incidence of adult type 2 diabetes (T2DM) is 11.
2%, showing an increasing momentum [1], as a common clinically used hypoglycemic weapon, the beginning of insulin The timing of treatment is mainly life>
.

However, diabetic patients often face the need to comprehensively weigh the pros and cons when using insulin therapy: the use of insulin ensures the efficacy of hypoglycemia, but at the same time, weight gain and the increased risk of hypoglycemia must be weighed
.

There is also a clinical problem that the insulin that can be used by general adult T2DM patients is not suitable for special populations.
For example, for patients with hyperglycemia during pregnancy and children with diabetes, the types of insulin that can be used are limited
.

Detemir can help doctors and patients balance the above problems
.

 Balance the hypoglycemic effectiveness and safety of insulin detemir.
Large-scale studies at home and abroad have confirmed the hypoglycemic effectiveness of insulin detemir
.

The PAPA study is a 24-week, randomized, open-label, parallel-group trial.
It included 70 patients with T2DM who used oral hypoglycemic agents to treat poor blood sugar control but did not receive insulin therapy.
They were randomly assigned at a ratio of 1:1, giving each Daily insulin detemir or insulin glargine treatment [2], the study found that after 24 weeks, HbA1c in the insulin detemir group decreased by 2.
9%, HbA1c decreased by 2.
7% in the insulin glargine group, and HbA1c decreased similarly, with no statistical difference (P =NS)
.

The fasting blood glucose (FPG) of the two groups of patients also had a significant decrease and the decrease was similar.
The FPG decreased by 5.
4mmol/L in the insulin detemir group and 4.
4mmol/L in the insulin glargine group (P=NS)
.

 In addition, real-world studies have also shown similar results.
The ORBIT study [3] enrolled nearly 20,000 T2DM patients in China who initiated basal insulin therapy due to poor control of oral hypoglycemic drugs.
The study found that the insulin detemir group HbA1c decreased by 2.
19%, HbA1c decreased by 2.
17% in the insulin glargine group (P=NS, detemir group vs.
glargine group), and HbA1c decreased by 2.
03% in the neutral insulin (NPH) group (P<0.
01, detemir group vs NPH group)
.

FPG decreased by 4.
0 mmol/L in insulin detemir group, FPG decreased by 3.
82 mmol/L in insulin glargine group (P=NS, detemir group vs.
glargine group), FPG decreased by 3.
43 mmol/L in NPH group (P<0.
01, detemir Group vs NPH Group)
.

This result shows that insulin detemir is equivalent to insulin glargine in reducing HbA1c and FPG, and is better than NPH
.

 Insulin detemir safety In terms of safety, a randomized, parallel, multi-center study abroad treated 476 T2DM patients for 26 weeks.
The study showed that the incidence of hypoglycemia in the insulin detemir group was 47% lower than that of the NPH group.
, The incidence of nighttime hypoglycemia was reduced by 55% [4], suggesting that when the glucose control effect is equivalent, the risk of hypoglycemia in patients using insulin detemir is lower than that of NPH
.

In addition, the COCHRANE meta-analysis analyzed 4 studies of 24 to 52 weeks that included 2550 patients and found that insulin detemir and insulin glargine were similar in safety, and there was no significant difference in the risk of hypoglycemia between the two groups (hazard ratio 0.
98, 95% CI 0.
92～1.
05) [5], the ORBIT study conducted on Chinese patients also found the same [3]
.

 Not only that, insulin detemir can also help patients reduce blood sugar fluctuations
.

Foreign studies have shown [6] that compared with insulin glargine, the area under the 12h GIR curve (27% vs 46%), the area under the 24h GIR curve (27% vs 48%), and the area under the insulin level curve of insulin detemir The coefficient of variation (23% vs 36%) was significantly lower (all P values ​​<0.
001), indicating that insulin detemir has lower day-to-day variability
.

 Balance hypoglycemic and weight management Insulin, insulin secretagogues and other hypoglycemic treatments are usually accompanied by weight gain.
Therefore, patients with secretagogues or insulin in the treatment plan are people who are at risk of weight gain, and weight gain will lead to patients Cardiovascular risk factors such as blood pressure and blood lipids are elevated [7]
.

However, the same insulin has different effects on body weight
.

Large-scale studies at home and abroad have shown that insulin detemir has a weight advantage compared to other basal insulins
.

The COCHRANE meta-analysis found that after patients randomly received insulin detemir or insulin glargine treatment, the two groups had similar anti-diabetic efficacy and safety, but the insulin detemir group gained significantly less weight than the insulin glargine group, with an average weight gain reduction of 0.
91 kg ( 95%CI -1.
21～-0.
61) (Figure 1) [5]
.

Figure 1 COCHRANE meta-analysis: Insulin detemir causes less weight gain.
China's large-scale basal insulin observational study ORBIT also showed that [3], insulin detemir caused significantly less weight gain than insulin glargine and NPH treatments (detemir group) vs Ganjing group: P=0.
032; Dite group vs NPH: P<0.
01) (Figure 2)
.

Therefore, when the original treatment plan contains secretagogues and needs to be combined with insulin therapy, choosing insulin detemir with less weight gain can balance the hypoglycemic effect and body weight
.

  *P<0.
01 vs NPH Figure 2 ORBIT study: Insulin detemir has a weight advantage to balance the needs of general patients and special patients.
Insulin detemir is the only basal insulin analog recommended for pregnancy in the 2020 edition of "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China" [ 1]
.

A number of randomized controlled trials (RCT) at home and abroad have confirmed the hypoglycemic efficacy and safety of insulin detemir in pregnant women[8-12]
.

For example, Han Zhen and other research results suggest that insulin detemir can effectively reduce FPG in patients with pregnancy complicated with diabetes, and the time for blood glucose to reach the target is shorter than that of NPH (P=0.
000) [9]
.

In addition, the study also found that compared with NPH, insulin detemir has a significantly lower incidence of hypoglycemia (P<0.
05), suggesting that its safety and effectiveness during pregnancy are better than NPH[9]
.

At the same time, the choice of insulin for pregnant people needs to consider the issue of affinity with insulin-like growth factor-1 (IGF-1) receptors.
Insulin detemir has a low affinity for IGF-1 receptors, which makes it easier for pregnant patients to treat hyperglycemia.
Peace of mind [11]
.

Therefore, the US Food and Drug Administration (FDA), the European Medicines Agency (EMA), and the China National Food and Drug Administration (NMPA) have successively approved detemir for the treatment of gestational diabetes
.

The American Association of Obstetricians and Gynecologists (ACOG), American Association of Endocrinologists (AACE) and many other associations, the 2020 version of the "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China" and the 2014 version of the "Guidelines for Diagnosis and Treatment of Diabetes in Gestational Diabetes" and many other guidelines recommend gestational diabetes The patient uses insulin detemir
.

In addition, insulin detemir can also be used to treat children and adolescent patients and elderly patients aged 6 years and above, which is suitable for a wide range of people and can balance the treatment needs of general patients and special patients
.

 Unique mechanism helps multi-party balance Deteinsulin can achieve multi-party balance thanks to its unique mechanism
.

Insulin detemir is a clear, neutral soluble preparation that does not form a precipitate after subcutaneous injection.
It is a soluble long-acting insulin analog with low variability [6] and good safety
.

 The liver mechanism of insulin detemir restores the insulin concentration gradient in the liver/peripheral tissues, weakens the anabolic effect in peripheral tissues [12], and can also improve central nervous system insulin resistance [13], reduce energy intake, increase energy consumption, and thereby Reduce weight gain
.

 Regarding the treatment needs of special populations, especially hypoglycemic reduction during pregnancy, because IGF-1 dysfunction may cause pre-eclampsia, spontaneous abortion, etc.
[14], pregnant people need to consider their IGF-1 receptor affinity when choosing insulin.
One factor, this is also a manifestation of the safety of insulin molecules
.

Insulin detemir has low affinity for IGF-1 receptors and weak mitogenic ability [11].
It is more comfortable to use in the treatment of hyperglycemia during pregnancy.
Therefore, it has been recommended by the 2020 edition of "China Type 2 Diabetes Prevention Guidelines"
.

Summary Insulin detemir can balance many factors, balance weight management and safety while ensuring efficacy, and is suitable for a wide range of people, especially for the special group of patients during pregnancy.
Insulin detemir is the 2020 edition of the "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China" 》The only recommended basal insulin analogue that can be used in pregnancy
.

Therefore, insulin detemir is a balanced choice for starting basal insulin therapy
.

 References: [1].
Diabetes Branch of Chinese Medical Association.
Chinese Journal of Diabetes.
2021;13(4):315-409.
[2].
Papa G.
et al.
G It Diabetol Metab.
2011;31:192- 198.
[3].
Ji L, et al.
Diabetes Obes Metab.
2017;19(8):1116-1126.
[4].
Hermansen K, et al.
Diabetes Care.
2006;29(6):1269-1274 .
[5].
Swinnen SG, et al.
Cochrane Database Syst Rev.
2011;(7):CD006383.
[6].
Heise T, et al.
Diabetes.
2004;53(6):1614-1620.
[7] .
Mattew J.
O'Brien et al.
JAMA Network Open.
2018;1(8):e186125.
[8].
Yang Huixia.
Chinese Journal of Diabetes.
2015;23(4):381-384.
[9].
Han Zhen , Et al.
Chinese Journal of Diabetes.
2017;25(4):325-329.
[10].
Mathiesen ER, et al.
Diabetes Care.
2012 35(10):2012-2017.
[11].
Kurtzhals P, et al .
Diabetes.
2000;49(6):999-1005.
[12].
Herring R, et al.
int J Obes Relat Metab Disord.
2004;28Suppl2:S23-28.
[13].
Tschritter O, et al.
PLoS One.
2007;2(11):e1196.
[14].
Niu Haiying.
Foreign Medical Obstetrics and Gynecology Section.
2004;31(4):238-240.
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