Two-way crossover comparison of insulin glargine and insulin detemir in basal-bolus therapy using continuous glucose monitoring

Shinya Abe1,2, Gaku Inoue1,2, Satoru Yamada1,3, Junichiro Irie1,3, Hiroyuki Nojima2, Kaoru Tsuyusaki2, Kensuke Usui2, Koichiro Atsuda2, Toshikazu Yamanouchi41Diabetes Center, Kitasato Institute Hospital, 2Center for Clinical Pharmacy and Clinical Sciences, Kitasato University, 3Department of Internal Medicine, Keio University School of Medicine, 4Department of Internal Medicine, University of Teikyo School of Medicine, Tokyo, JapanObjective: This study aimed to compare the glucose-lowering effect and glycemic variability of insulin glargine with those of insulin detemir.Material and methods: This was an open-label, single-center, randomized, two-way crossover study in patients with diabetes on basal-bolus insulin therapy, with neutral protamine Hagedorn (NPH) insulin as basal insulin. Patients switched from NPH insulin to a course either of insulin glargine followed by insulin detemir, or insulin detemir followed by insulin glargine, continuing the same dose of the prior bolus of insulin. To evaluate the glucose-lowering effect, daily glycemic profiles were recorded for 72 hours by continuous glucose monitoring (CGM) in an outpatient setting. The mean amplitude of glycemic excursions, standard deviation (SD), and the mean of daily difference (MODD) were used to assess intraday and day-to-day glycemic variability.Results: Eleven patients were enrolled and nine completed the study. Mean blood glucose calculated from CGM values was significantly lower with insulin glargine compared with insulin detemir (9.6 ± 2.4 mmol/L versus 10.4 ± 2.8 mmol/L, P = 0.038). The SD was significantly lower with insulin glargine versus insulin detemir (2.5 ± 0.9 mmol/L vs 3.5 ± 1.6 mmol/L, P = 0.011). The MODD value was significantly lower with insulin glargine than with insulin detemir (2.2 ± 1.1 mmol/L vs 3.6 ± 1.7 mmol/L, P = 0.011). There was no significant difference between the two insulin analogs in terms of hypoglycemia.Conclusion: This study suggests that insulin glargine leads to more effective and more stable glycemic control than the same dose of insulin detemir.Keywords: continuous glucose monitoring, insulin detemir, insulin glargine