Abstract

Type 1 and 2 diabetes are lifelong diseases. Strict metabolic control is important in prevention and delay of development of late complications in subjects with diabetes. However, one of the barriers for optimal control is that low and relatively constant basal insulin levels between meals and at night are difficult to obtain with currently available basal insulin such as NPH. In addition, bedtime administration of NPH can lead to peak insulin level 3-8 h after administration, and potential nocturnal hypoglycaemia. Novel long lasting insulin analogues glargine and detemir are designed to follow the level of basal insulin more pshysiologically. Insulin detemir and insulin glargine have prolonged duration and are comparable to NPH insulin. From the pharmacokinetic and pharmacodynamic point of view, detemir has an effect similar to that of glargin on glucose control during initial 24h after administration, but the effect decreases during  12-24h. For this reason, detemir should be administered twice per day.
Clinical studies have demonstrated more stable glucose blood level and a significantly reduced risk of daily and noctural hypoglycaemia glargine and detemir compared with NPH insulin.
Recent studies have shown similar effects of once-daily insulin glargin and twice daily insulin detemir on glucaemic control and comparable risk of hypoglycaemia. Some studies have demonstrated the superiority of insulin glargine to reach HbA1c targets in comparison with insulin detemir.
Both insulin glargin and insulin detemir have comparable effects on weight gain. Further randomized comparable studies are needed to clarify the clinical effects and benefits of both novel basal insulins.