Abstract
Dear Editor:
Table 1 shows the correct time–action profiles of two Novo Nordisk insulin products, in place of the values published in Table 5 (p. S-89). 1
Correct time–action profiles are indicated in bold type, taken from the respective package inserts. 2,3
Pharmacokinetic values indicating time to peak concentration.
In addition, in support of the following statement on p. S-88, “The patient needs to be made aware of the different insulins available to him or her (Tables 4 and 5) and their different action profiles (Fig. 1),” the action profiles of biphasic (premixed) insulins should be included in Figure 1 (p. S-89) 1 for readers to have a comprehensive overview of all available insulin types.
Mean glucose infusion rate profiles for insulin detemir versus insulin glargine. Reproduced with permission from Klein et al. 5
Insulin detemir is inaccurately represented, where it should follow a similar glucose infusion rates curve as insulin glargine. Insulin detemir has a relatively flat action profile with a duration of action up to 24 h. 4 Because the article 1 addresses the type 2 diabetes patient population, it would be more appropriate to reference studies with action profiles reflecting this patient population, such as Klein et al, 5 and Bilz et al. 6 described below instead of publications with a type 1 diabetes patient population.
The following studies have demonstrated that insulin detemir and insulin glargine have similar time–action profiles. Klein et al. 5 compared the pharmacodynamics and pharmacokinetics parameters of 0.4, 0.8, and 1.4 U/kg doses of insulin detemir and insulin glargine in a randomized, double-blind, six-period, crossover, 24-h euglycemic clamp study. The study included 27 male patients with type 2 diabetes having glycosylated hemoglobin values of 7.7% and 7.5% in the insulin detemir and insulin glargine arms, respectively. Both insulin products demonstrated an increased effect with higher doses (Table 2 and Fig. 1).
Reproduced with permission from Klein et al. 5
The mean glucose infusion rate profiles of insulin detemir and insulin glargine were similar for 0.4 and 0.8 U/kg doses (Fig. 1) in shape and flatness, where the P value for equal slopes is 0.23 and for equal intercepts is 0.84. Also, at the highest dose of 1.4 U/kg, there was no significant difference in pharmacodynamics between insulin detemir and insulin glargine.
The pharmacodynamics and pharmacokinetics properties of insulin detemir and insulin glargine, both dosed at 0.8 and 1.6 U/kg, were studied in another randomized, crossover, 30-h euglycemic clamp study in 10 patients with type 2 diabetes. 6 Baseline characteristics were as follows: age, 55.7 years; body mass index, 43.2 kg/m2; and glycosylated hemoglobin, 7.2%. The plasma glucose concentration was maintained at 99 mg/dL. A dose–response effect (i.e., higher doses had a greater effect) was observed for both insulin analogs. During the first 24 h after injection, insulin detemir and insulin glargine showed a similar pharmacodynamics profile; no statistically significant differences were seen in the maximum and area under the curve glucose infusion rate levels between the two basal insulins. Between 24 h and the end of the clamp, the area under the curve for insulin glargine was higher compared with insulin detemir (P=0.03).
We appreciate your review and consideration of the concerns identified above for a published correction in Diabetes Technology & Therapeutics to prevent dissemination of inaccurate or incomplete information.