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MELISSA C. JONES, PHARM.D., BCPS, is Assistant Dean of Admissions and Assistant Professor of Pharmacy Practice, School of Pharmacy; and MALLIKA PATEL, PHARM.D., is Assistant Professor of Pharmacy Practice, School of Pharmacy, South University, Savannah, GA.

Address correspondence to Dr. Jones at the School of Pharmacy, South University, 709 Mall Boulevard, Savannah, GA 31406 (mjones{at}southuniversity.edu).

Purpose. The pharmacology, pharmacokinetics, efficacy and tolerability, safety, drug interactions, dosage and administration, cost, and place in therapy of insulin detemir are reviewed. Summary. Insulin detemir is a long-acting, neutral, and soluble insulin analogue with a lower within-subject variability of fasting plasma glucose levels than isophane insulin human (NPH insulin) and insulin glargine. The lower within-subject variability of insulin detemir may decrease hypoglycemic events, especially nocturnal events, and may contribute to a decreased incidence of weight gain. In vivo, insulin detemir is 98–99% bound to albumin—one of the mechanisms contributing to its long duration of action. Several open-labeled, randomized, multicenter trials have been conducted comparing the safety and efficacy of insulin detemir to NPH insulin in patients with type 1 or type 2 diabetes mellitus. In most trials, patients were randomized to receive insulin on three different dosing schedules: basal insulin twice daily before breakfast and at bedtime, basal insulin at 12-hour intervals, or basal insulin before breakfast and dinner. Mealtime insulin was given as part of the basal–bolus therapy. Glycosylated hemoglobin values were similar in patients receiving insulin detemir or NPH insulin. Insulin detemir appears to be well tolerated. The most common adverse effects reported during clinical trials were hypoglycemia, headache, dizziness, and injection-site reactions. Conclusion. Insulin detemir given once or twice daily as part of basal–bolus insulin therapy is at least as effective as NPH insulin in maintaining overall glycemic control in adult patients with type 1 or type 2 diabetes mellitus. Index terms: Binding; Costs; Diabetes mellitus; Dosage; Drug administration; Drug interactions; Duration of action; Insulin detemir; Insulins; Pharmacokinetics; Sustained-action medications; Toxicity