May 7, 2003
Question from Wasilla, Alaska, USA:
How is Detemir different from the existing insulins? When will it be released to use in the US?
Detemir is another of the substituted semisynthetic insulins. It has one amino acid change at the end of the B chain and is also conjugated with a medium chain fatty acid. This latter quality allows it to be linked to serum albumin from which it is evenly released. This peakless quality enables it to be used as a 24 hour baseline insulin with short acting insulins to cover the after meal glucose peak.
Clinical trials are still going on in the U.S. so I think it will be some months yet before it is finally approved by the FDA. However, it has been extensively used in Europe and Japan. To date, there is no evidence that a NovoLog/Detemir regimen offers any advantages over the available Humalog/Lantus (insulin glargine) system.
Finally Detemir has the advantage that it is mixable with other short acting insulins; but on the other hand it has to be given twice a day and it is also, because of its albumin binding, less biologically effective than other insulins — or in other words, needs a higher dose.