Are Insulin Analogues Detemir or Glulisine Used Preferentially in Overweight/Obese Subjects? A German Multicentre Analysis of 38560 Type 2 Diabetic Patients from the DPV Registry

B. Bohn; N. Scheuing; P. M. Jehle; K. Laubner; B. Born; S. Merger; M. Hummel; D. Krakow; A. Voll; A. Zimmermann; S. Zimny; R. W. Holl; for the DPV and APV initiatives and the German BMBF Competence Networks Diabetes mellitus and Obesity

doi:10.1055/s-0034-1383646

Experimental and Clinical Endocrinology & Diabetes, Table of Contents

Exp Clin Endocrinol Diabetes 2014; 122(10): 602-607
DOI: 10.1055/s-0034-1383646

Article

Are Insulin Analogues Detemir or Glulisine Used Preferentially in Overweight/Obese Subjects? A German Multicentre Analysis of 38560 Type 2 Diabetic Patients from the DPV Registry

B. Bohn

¹Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany

,

N. Scheuing

¹Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany

,

P. M. Jehle

²Department of Internal Medicine, Academic Hospital Paul Gerhardt Stift, Lutherstadt Wittenberg, Martin- Luther-University Halle-Wittenberg, Germany

,

K. Laubner

³Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Freiburg, Germany

,

B. Born

⁴Department of Diabetology and Infectiology, Medical Clinic I, Reutlingen, Germany

,

S. Merger

⁵Division of Endocrinology, Diabetes and Metabolism, Graduate School of Molecular Diabetology and Endocrinology, Ulm University, Ulm, Germany

,

M. Hummel

⁶Specialized Diabetes Practice, Rosenheim, Germany

,

D. Krakow

⁷Diabetes Centre Forchheim, Germany

,

A. Voll

⁸Specialized Diabetes Practice, Traunstein, Germany

,

A. Zimmermann

⁹Specialized Diabetes Practice, Bad Aibling, Germany

,

S. Zimny

¹⁰Department for General Internal Medicine, Endocrinology and Diabetes, HELIOS Kliniken Schwerin, Schwerin, Germany

,

R. W. Holl

¹Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany

,

for the DPV and APV initiatives and the German BMBF Competence Networks Diabetes mellitus and Obesity

› Author Affiliations

Abstract

Objective: Several studies suggest benefits of insulin analogues detemir or glulisine in overweight and obese patients with type 2 diabetes. The present multicentre study therefore examines, whether these insulin analogues are used more frequently in patients with increased body mass index.

Methods: Data of 38 560 adult type 2 diabetic patients using insulin analogues, from 150 centres in Germany, registered in a standardized, prospective, computer-based documentation program (DPV), were included. Patients were classified into body mass index categories according to World Health Organization. Analysis was stratified by 3 time periods. To adjust for confounding effects, multivariable logistic regression models were created.

Results: Detemir was preferentially used in overweight (OR 1.36, 95%-CI 1.20–1.53) and obese patients (OR 2.06, 95%-CI 1.84–2.31) compared to normal-weight patients. These effects remained significant after adjusting for sex, age, new/old federal state of Germany, size of centre, treatment in university clinic and clinic/specialized private practice. Models were additionally adjusted for time period and interaction of BMI category with age or sex. For glulisine, a minor effect was present when comparing obese to normal-weight patients (OR 1.26, 95%-CI 1.06–1.50). After adjustment, this finding was no longer significant. Stratified by obesity grade, class III obese patients more frequently used detemir or glulisine compared to class I obese patients. Comparing time periods, odds ratios did not differ, neither for detemir nor for glulisine.

Conclusion: Detemir is used more often in overweight and obese patients compared to normal-weight patients. For glulisine, the relationship is less pronounced.

Key words

insulin analogues - detemir - glulisine - type 2 diabetes - body mass index

Full Text

References

References
1 de Boer H, Jansen M, Koerts J et al. Prevention of weight gain in type 2 diabetes requiring insulin treatment. Diabetes Obes Metab 2004; 6: 114-119
2 Barnett AH. How well do rapid-acting insulins work in obese individuals?. Diabetes Obes Metab 2006; 8: 388-395
3 Montañana CF, Herrero CH, Fernández MR. Less weight gain and hypoglycaemia with once-daily insulin detemir than NPH insulin in intensification of insulin therapy in overweight type 2 diabetes patients – The PREDICTIVE™ BMI clinical trial 1. Diabetic Med 2008; 25: 916-923
4 Meneghini LF, Orozco-Beltran D, Khunti K et al. Weight beneficial treatments for type 2 diabetes. J Clin Endocrinol Metab 2011; 96: 3337-3353
5 Anderson JW, Kendall CWC, Jenkins DJA. Importance of weight management in type 2 diabetes: review with meta-analysis of clinical studies. J Am Coll Nutr 2003; 22: 331-339
6 Scheuing N, Bayer C, Best F et al. Is there a benefit to use calculated percent body fat or age- and gender-adjusted BMI-SDS_LMS to predict risk factors for cardiovascular disease? A German/Austrian multicenter DPV-Wiss analysis on 42 048 type 2 diabetic patients. Exp Clin Endocrinol Diabetes 2013; 121: 67-74
7 Morello CM. Pharmacokinetics and pharmacodynamics of insulin analogs in special populations with type 2 diabetes mellitus. Int J Gen Med 2011; 4: 827-835
8 Pieber TR, Treichel HC, Hompesch B et al. Comparison of insulin detemir and insulin glargine in subjects with type 1 diabetes using intensive insulin therapy. Diabet Med 2007; 24: 635-642
9 Peterson GE. Analog insulin detemir for patients with type 1 and type 2 diabetes: a review. Diabetes Metab Syndr Obes 2009; 2: 31-36
10 Marre M, Pinget M, Gin H et al. Insulin detemir improves glycaemic control with less hypoglycaemia and no weight gain: 52-week data from the PREDICTIVE study in a cohort of French patients with type 1 or type 2 diabetes. Diabetes Metab 2009; 35: 469-475
11 Swinnen SG, Simon AC, Holleman F et al. Insulin detemir versus insulin glargine for type 2 diabetes mellitus. Cochrane Database Syst Rev 2011; 6 CD006383
12 Zhuang YG, Peng H, Huang F. A meta-analysis of clinical therapeutic effect of insulin glargine and insulin detemir for patients with type 2 diabetes mellitus. Eur Rev Med Pharmacol Sci 2013; 17: 2566-2570
13 Raslova K, Tamer SC, Clauson P et al. Insulin detemir results in less weight gain than NPH insulin when used in basal-bolus therapy for type 2 diabetes mellitus, and this advantage increases with baseline body mass index. Clin Drug Investig 2007; 27: 279-285
14 Hermansen K, Davies M. Does insulin detemir have a role in reducing risk of insulin-associated weight gain?. Diabetes Obes Metab 2007; 9: 209-217
15 Heise T, Nosek L, Spitzer H et al. Insulin glulisine: a faster onset of action compared with insulin lispro. Diabetes Obes Metab 2007; 9: 746-753
16 Becker RHA, Frick AD. Clinical pharmacokinetics and pharmacodynamics of insulin glulisine. Clin Pharmacokinet 2008; 47: 7-20
17 Becker RHA, Frick AD, Burger F et al. Insulin glulisine, a new rapid-acting insulin analogue, displays a rapid time-action profile in obese non-diabetic subjects. Exp Clin Endocrinol Diabetes 2005; 113: 435-443
18 Bolli GB, Luzio S, Marzotti S et al. Comparative pharmacodynamic and pharmacokinetic characteristics of subcutaneous insulin glulisine and insulin aspart prior to a standard meal in obese subjects with type 2 diabetes. Diabetes Obes Metab 2011; 13: 251-257
19 Luzio S, Peter R, Dunseath GJ et al. A comparison of preprandial insulin glulisine versus insulin lispro in people with type 2 diabetes over a 12-h period. Diabetes Res Clin Pract 2008; 79: 269-275
20 Scheuing N, Best F, Dapp A et al. Multicentre analysis of 178,992 type 2 diabetes patients revealed better metabolic control despite higher rates of hypertension, stroke, dementia and repeated inpatient care in patients with comorbid Parkinson’s disease. Parkinsonism Relat Disord 2013; 19: 687-692
21 Kapellen T, Wolf J, Rosenbauer J et al. Changes in the use of analogue insulins in 37 206 children and adolescents with type 1 diabetes in 275 German and Austrian centers during the last twelve years. Exp Clin Endocrinol Diabetes 2009; 117: 329-335
22 Laubner K, Molz K, Kerner W et al. Daily insulin doses and injection frequencies of Neutral Protamine Hagedorn (NPH) insulin, insulin detemir and glargine in type 1 and type 2 diabetes: a multicenter analysis of 51 964 patients from the German/Austrian DPV-Wiss database. Diabetes Metab Res Rev 2013; Epub 2013 Dec 3
23 Arnolds S, Rave K, Hovelmann U et al. Insulin glulisine has a faster onset of action compared with insulin aspart in healthy volunteers. Exp Clin Endocrinol Diabetes 2010; 118: 662-664
24 Home PD. The pharmacokinetics and pharmacodynamics of rapid-acting insulin analogues and their clinical consequences. Diabetes Obes Metab 2012; 14: 780-788
25 Russell-Jones DL, Khan R. Insulin-associated weight gain in diabetes – causes, effects and coping strategies. Diabetes Obes Metab 2007; 9: 799-812
26 Hordern SVM, Wright JE, Umpleby AM et al. Comparison of the effects on glucose and lipid metabolism of equipotent doses of insulin detemir and NPH insulin with a 16-h euglycaemic clamp. Diabetologia 2005; 48: 420-426
27 Hollander PA. Insulin detemir for the treatment of obese patients with type 2 diabetes. Diabetes Metab Syndr Obes 2012; 5: 11-19