Introduction: Type 2 diabetes represents an important health problem and is designated by a progressive course, and the subsequent long-term insulin therapy to achieve optimal glucose control. It is important to stress that a substantial number of patients do not achieve optimal glucose control despite the usage of two doses of premixed insulin. Detemir insulin, along with a low pharmacodynamic coefficient of variability, exhibits anorexigenic features, through its effects on the CNS. The aim of the study was to determine the reduction in HbA1c and weight reduction in type 2 diabetic patients switched from premixed insulin analogues to aspart and detemir insulin.
Patients and methods: 57 uncontrolled diabetic patients (26 males, 31 females, mean age 65.5±7.0 years, and diabetes duration 16.8±6.0 years) were enrolled and followed for 1 year. At the study entry patients were treated with premixed insulin analogues and switched to three doses of aspart preprandial, and one dose of detemir bedtime.
Results: 26.3% of subjects achieved HbA1c < 7%. A difference was observed in mean fasting plasma glucose (12.3±2.8 vs 9.3±2.4 mmol/l, P<0.001)) and mean HbA1c (8.48±0.83 vs 7.7±0.83%, P=0.0002). Body weight reduction of 3.45±1.81 kg was observed in the group of 22 patients with the highest BMI (32.54±3.24 kg/m2). In 14 patients (BMI 31.07±2.91 kg/m2) no change in body weight was found. Group of 21 patients with the lowest BMI (29.11±2.65 kg/m2) gained 2.5±1.1 kg.
Conclusion: Intensification of insulin therapy with aspart and detemir resulted in significant improvement of glycaemic control, as well as in the reduction of body weight in 38.6% of patients. Exhibition of anorexigenic features of detemir with effect on body weight could be explained by the difference in dopaminergic activity.