1 / 20

Insulin detemir: weight neutral

Insulin detemir: weight neutral . Hans Häring Germany. Agenda. The problem of weight gain in insulin-treated diabetes Effect of insulin detemir on weight Possible mechanisms explaining differential insulin detemir and NPH insulin weight outcomes . Weight gain in type 1 diabetes in the DCCT.

ada
Télécharger la présentation

Insulin detemir: weight neutral

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Insulin detemir: weight neutral Hans Häring Germany

  2. Agenda • The problem of weight gain in insulin-treated diabetes • Effect of insulin detemir on weight • Possible mechanisms explaining differential insulin detemir and NPH insulin weight outcomes

  3. Weight gain in type 1 diabetes in the DCCT Intensive therapy Conventional therapy p < 0.0001 6 30 5 20 4 Change in mean weight (kg) Change in weight (kg) 3 10 2 0 1 0 – 10 1st 2nd 3rd 4th n = 146 n = 131 Weight gain (quartiles) at mean follow up of 6.1 years Initial 12 months DCCT. Diabetes Care 1988;11:567-73 and Purnell et al. JAMA 1998;280:140-46

  4. * p < 0.01 compared with baseline and first quartile at follow up Cardiovascular risk factors increase with weight gain in type 1 diabetes (DCCT) Total cholesterol SystolicBP DiastolicBP HDL LDL 8 * * 6 * * 4 2 Percent change from baseline 0 –2 Gained the most weight(fourth quartile of weight gain) –4 * –6 Gained the least weight(first quartile of weight gain) –8 –10 Patients on intensive insulin therapy – changes from baseline to follow up (mean 6.1 years) Purnell et al. JAMA 1998;280(2):140-6.

  5. In the UKPDS, insulin-treated patients with type 2 diabetes gained the most weight 10 insulin conventional 7.5 chlorpropamide glibenclamide 5 Change in weight (kg) metformin 2.5 0 0 3 6 9 12 Years from randomisation –2.5 While patients on all therapies gained weight, patients receiving insulin gained the most UKPDS 34. Lancet 1998:352:854–865.

  6. Cardiovascular risk factors and weight in patients with type 2 diabetes • Possible multiple CV risk factors at time of diagnosis of type 2 diabetes • Bodyweight and CV risk are associated1 • Losing weight improves CV risk profiles2 • In a study of 100 people with type 2 diabetes treated with insulin or insulin/OAD therapy, all gained weight3 • Systolic BP and LDL cholesterol levels increased • Weak but positive relationship between systolic BP and weight gain (r=0.22) 1. Anderson JW, Kendall CW, Jenkins DJ. J Am Coll Nutr 2003;22(5):331-9. 2. Markovic TP et al. Diabetes Care 1998;21(5):695-700. 3. Yki-Jarvinen H et al. J Clin Endocrinol Metab 1997;82(12):4037-43.

  7. Why do people on insulin gain weight? • Better glycaemic control –  glycosuria1 • Anabolic effects of insulin –  fat storage2 • Decreased basal metabolic rate – less energy expenditure1 • Defensive eating against hypoglycaemia 1. Carlson et al. Diabetes 1993;42:1700-1707 2. Birkeland et al. J Intern Med 1994;236:305-13

  8. Effect of insulin detemir on weight1. Long-term study • 12-month comparison. Basal-bolus insulin aspart plus NPH insulin or insulin detemir • Patients with type 1 diabetes, n = 315 De Leeuw et al. (in press 2004)

  9. Change in weight with insulin detemir vs. NPH insulin in patients with type 1 diabetes p < 0.001 (12 months) 1.2 Insulin detemir NPH insulin 0.6 Change in weight (kg) 0 –0.6 3 6 9 12 Months De Leeuw et al. (in press 2004)

  10. Effect of insulin detemir on weight2. Children and adolescents • 6-month comparison. Basal-bolus insulin aspart plus NPH insulin or insulin detemir • Patients aged 6-17 with type 1 diabetes, n = 347 De Leeuw et al. (in press 2004)

  11. 0.8 0.7 p < 0.001 0.6 0.5 0.4 Change in BMI (kg/m2 ) 0.3 0.2 0.1 0 Weight and BMI, insulin detemir vs. NPH insulin, children & adolescents, type 1 diabetes 4.0 3.5 p < 0.001 3.0 2.5 2.0 Change in weight (kg) 1.5 1.0 0.5 0 NPH Insulin detemir Robertson et al. Diabetes 2004;53 (Suppl. 2):A144

  12. 0.8 0.7 p = 0.002 0.6 0.5 p = 0.004 0.4 Change in BMI (kg/m2 ) 0.3 0.2 0.1 0 6 – 11 12 – 17 Weight and BMI, insulin detemir vs. NPH insulin, children & adolescents, type 1 diabetes NPH 4.0 Insulindetemir 3.5 p = 0.003 3.0 p = 0.009 2.5 Change in weight (kg) 2.0 1.5 1.0 0.5 0 Age (yrs): 12 – 17 6 – 11 Robertson et al. Diabetes 2004;53 (Suppl. 2):A144

  13. Effect of insulin detemir on weight3. Type 2 diabetes treat-to-target trials • 24-week addition of basal insulin to OADs in insulin-naive patients with type 2 diabetes De Leeuw et al. (in press 2004)

  14. Insulin glargine vs. NPH insulinTreat-to-target trial: HbA1c and weight 9.0 3.5 NPH + OAD + 3.0 kg + 2.8 kg 3 Insulin glargine + OAD 8.5 2.5 8.0 Change in weight from baseline to endpoint (kg) 2 HbA1c (%) 7.5 1.5 7.0 1 6.5 0.5 0 0 4 8 12 16 20 24 Insulin glargine + OAD NPH + OAD Weeks Riddle et al. Diabetes Care 2003;26:3080-3086

  15. Insulin detemir vs. NPH insulinTreat-to-target trial: HbA1c and weight p < 0.05 9.0 3.5 Insulin detemir + OAD + 2.8 kg 3 NPH + OAD 8.5 2.5 8.0 Change in weight from baseline to endpoint (kg) 2 HbA1c (%) 7.5 + 1.2 kg 1.5 7.0 1 6.5 0.5 0 24 Insulin detemir+ OAD NPH + OAD 0 12 -2 Weeks Accepted at EASD 2004 as Poster 754:PS 64.

  16. Less weight gain with insulin detemir than NPH insulin – a rapid and sustained effect Insulin detemir NPH 86 85 p < 0.001 84 83 Weight (kg) 82 81 0 -2 1 3 5 7 9 11 13 15 17 19 21 23 Weeks Hermansen et at EASD 2004 Poster 754:PS 64.

  17. Effect of insulin detemir on weight4. Overview of phase III studies

  18. Weight change: insulin detemir phase III studies Insulin detemir *p<0.05, insulin detemir vs NPH 2 NPH insulin * * * * * * * * * * * 1.5 1 Weight change (kg) 0.5 0 type 2 diabetes -0.5 # † ‡ ## -1 Haak Home Vague Home Standl Pieber Pieber Rašlová De Leeuw Hermansen Russell-Jones †IDet (am+bed); ‡IDet (am+predinner); #IDet (12hourly); ##IDet (am+bed)

  19. Possible mechanisms for reduced weight gain with insulin detemir • Reduced snacking due to reduced risk of hypoglycaemia? • Increased ratio of hepatic:peripheral activity? • A CNS effect?

  20. Conclusion • Weight gain is associated with insulin treatment in people with type 1 and type 2 diabetes • The consequences of gaining weight or being overweight can be serious and are worrying in people with type 1 or type 2 diabetes • Treatment with insulin detemir results in good glycaemic control without weight gain

More Related