Comparison of three multiple injection regimens for Type 1 diabetes: morning plus dinner or bedtime administration of insulin detemir vs. morning plus bedtime NPH insulin

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Abstract
Aims This trial investigated the efficacy and safety of two different administration-time regimens with insulin detemir (IDet) to that of a conventional basal insulin regimen with NPH insulin (NPH). Methods This multinational, 16-week, open, parallel group trial included 400 people with Type 1 diabetes mellitus (DM) randomized to IDet either morning and before dinner (IDet(morn+din)) or morning and bedtime (IDet(morn+bed)), or to NPH morning and bedtime (NPHmorn+bed), all in combination with mealtime insulin aspart (IAsp). Results HbA(1c) was comparable between the three groups after 16 weeks (P = 0.64), with reductions of 0.39-0.49% points. Lower fasting plasma glucose (FPG) was observed with IDet(morn+din) and IDet(morn+bed) compared with NPHmorn+bed (9.8 and 9.1 vs. 11.1 mmol/l, P = 0.006), whereas the IDet groups did not differ (P = 0.15). Within-person variation in self-measured FPG was significantly lower for both IDet regimens (SD IDet(morn+din) 2.5, IDet(morn+bed) 2.6 mmol/l) than for NPHmorn+bed (SD 3.1 mmol/l, P < 0.001), but was comparable between the IDet groups (P = 0.48). Ten-point plasma glucose profiles were lower between dinner and breakfast in the IDet(morn+din) group (P = 0.043), compared with the two other groups. Risk of overall and nocturnal hypoglycaemia was similar for the three groups. Lower mean bodyweight was observed with IDet compared with NPH after 16 weeks (difference: IDet(morn+din)-1.3 kg, P < 0.001, IDet(morn+bed)-0.6 kg, P = 0.050). Conclusions Both IDet regimens were well tolerated and provided lower and less variable glucose levels with no, or less, weight gain than NPH at comparable HbA(1c). IDet can be administered either at dinner or bedtime, with similar glycaemic control according to the need of the individual person. Pieber T R, Grill V, Kristensen A, Draeger E: Treatment with insulin detemir allows flexible timing of administration in subjects with Type 1 diabetes. Diabetes 2003; 52 (Suppl. 1): A130.