The Comparative Dosing and Glycemic Control of Intermediate and Long-Acting Insulins in Adult Patients With Type 1 and 2 Diabetes Mellitus.

Content Provider	Europe PMC
Author	Kabakov, Anna Merker, Andrew
Copyright Year	2021
Description	Objective: The various basal insulin products possess differences in pharmacokinetics that can significantly impact glycemic control and total daily basal insulin dosing. In addition, there will be instances where transitions between the different long-acting insulins will need to be made. Because every basal insulin product is not interchangeable on a 1:1 unit-to-unit basis, it is important for health care providers to understand the expected dose adjustments necessary to maintain a similar level of glycemic control. Data Sources: A Medline and Web of Science search was conducted in September 2021 using the following keywords and medical subjecting headings: NPH, glargine, detemir, type 1 diabetes mellitus, and type 2 diabetes mellitus. Study Selection and Data Extraction: Included articles were those that followed adult patients with type 1 diabetes mellitus and/or type 2 diabetes mellitus and compared the following types of insulin: “NPH and glargine,” “NPH and detemir,” and “glargine and detemir” for at least 4 weeks, had documented basal insulin (BI) doses, and excluded pregnant patients. Data synthesis: Twenty-five articles were found that include adult type 1 and/or type 2 diabetes mellitus patients. Once daily NPH can be converted unit-to-unit to glargine or detemir. Twice daily NPH converted to glargine or detemir requires an initial 20% reduction in BI dose. An increase in dose of BI is recommended when transitioning from glargine to detemir. Glargine and detemir consistently resulted in improved glycemic control with lower incidence of hypoglycemic events compared with NPH. Conclusions: When transitioning between long-acting insulins, the doses are not always interchangeable on a 1:1 basis. Unit dose adjustments are likely if transitioning between BIs and can influence short-term parameters in the acute care setting and long-term parameters in the outpatient setting.
Abstract	Objective: The various basal insulin products possess differences in pharmacokineticsthat can significantly impact glycemic control and total daily basal insulindosing. In addition, there will be instances where transitions between thedifferent long-acting insulins will need to be made. Because every basalinsulin product is not interchangeable on a 1:1 unit-to-unit basis, it isimportant for health care providers to understand the expected doseadjustments necessary to maintain a similar level of glycemic control. Data Sources: A Medline and Web of Science search was conducted in September 2021 using thefollowing keywords and medical subjecting headings: NPH, glargine, detemir,type 1 diabetes mellitus, and type 2 diabetes mellitus. Study Selection and Data Extraction: Included articles were those that followed adult patients with type 1diabetes mellitus and/or type 2 diabetes mellitus and compared the followingtypes of insulin: “NPH and glargine,” “NPH and detemir,” and “glargine anddetemir” for at least 4 weeks, had documented basal insulin (BI) doses, andexcluded pregnant patients. Data synthesis: Twenty-five articles were found that include adult type 1 and/or type 2diabetes mellitus patients. Once daily NPH can be converted unit-to-unit toglargine or detemir. Twice daily NPH converted to glargine or detemirrequires an initial 20% reduction in BI dose. An increase in dose of BI isrecommended when transitioning from glargine to detemir. Glargine anddetemir consistently resulted in improved glycemic control with lowerincidence of hypoglycemic events compared with NPH. Conclusions: When transitioning between long-acting insulins, the doses are not alwaysinterchangeable on a 1:1 basis. Unit dose adjustments are likely iftransitioning between BIs and can influence short-term parameters in theacute care setting and long-term parameters in the outpatient setting.
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ISSN	87551225
Volume Number	38
DOI	10.1177/87551225211055700
PubMed Central reference number	PMC8820046
Issue Number	1
PubMed reference number	35141727
Journal	The Journal of Pharmacy Technology : JPT : Official Publication of the Association of Pharmacy Technicians [J Pharm Technol]
e-ISSN	15494810
Language	English
Publisher	SAGE Publications
Publisher Date	2021-11-10
Publisher Place	Sage CA: Los Angeles, CA
Access Restriction	Open
Rights License	© The Author(s) 2021
Subject Keyword	basal insulin long-acting insulin insulin conversion
Content Type	Text
Resource Type	Article
Subject	Pharmaceutical Science