Insulin Detemir Reduces Weight Gain as a Result of Reduced Food Intake in Patients With Type 1 Diabetes

Abstract

OBJECTIVEInsulin detemir lacks the usual propensity for insulin to cause weight gain. We investigated whether this effect was a result of reduced energy intake and/or increased energy expenditure.RESEARCH DESIGN AND METHODSA 32-week, randomized crossover design trial was undertaken in 23 patients with type 1 diabetes. Patients on a basal-bolus regimen (with insulin aspart as the bolus insulin) were randomly assigned to insulin detemir or NPH insulin as a basal insulin for 16 weeks, followed by the other basal insulin for 16 weeks. At the end of each 16-week period, total energy expenditure, resting energy expenditure, diet-induced thermogenesis, activity energy expenditure, energy intake, weight change, glycemic control, hypoglycemic episodes, and hormones that affect satiety and fuel partitioning were measured.RESULTSAfter 16 weeks, weight change was −0.69 ± 1.85 kg with insulin detemir and +1.7 ± 2.46 kg with NPH insulin (P < 0.001). Total energy intake was significantly less with insulin detemir (2,016 ± 501 kcal/day) than with NPH insulin (2,181 ± 559 kcal/day) (P = 0.026). There was no significant difference in any measure of energy expenditure, HbA1c percentage, or number of hypoglycemic episodes. Leptin was lower and resistin was higher with insulin detemir compared with NPH insulin (P = 0.039, P = 0.047). After the meal, ghrelin and pancreatic polypeptide levels (P = 0.002, P = 0.001) were higher with insulin detemir.CONCLUSIONSThe reduced weight gain with insulin detemir compared with NPH insulin is attributed to reduced energy intake rather than increased energy expenditure. This may be mediated by a direct or indirect effect of insulin detemir on the hormones that control satiety.

Observational 6-Month Open-Label Study of Japanese Type 2 Diabetes Patients Switching from NPH Insulin to Insulin Detemir in Basal—Bolus Regimen: 23rd Article of the Japan Diabetes Clinical Data Management Study Group (JDDM23)

“…In a randomized crossover study, it was found that the weight sparing effect of insulin detemir was due to reduced food intake rather than increased energy expenditure, possibly through direct or indirect effects of insulin detemir on the hormones that control satiety. 25 This concept is supported by the finding that insulin detemir activates the hypothalamus, 26 which centrally controls appetite and body weight. 27 There were certain limitations to the present study, including the small sample size and observational study design.…”

Weight‐sparing effect of insulin detemir: a consequence of central nervous system‐mediated reduced energy intake?

“…Overall, despite a limited study population and an open‐label design, the findings of Zachariah et al. 26 suggest that the weight‐sparing effect of insulin detemir can be attributed to reduced caloric intake. Moreover, the study further confirms that change in energy intake is not linked to hypoglycaemia.…”

Detemir potential applications in the treatment of diabetes during pregnancy: proven benefits and perspectives

“…This effect of insulin detemir (Levemir) on body weight may result from its effect on the brain, as well as the ability of the central nervous system to help regulate hunger and satiety, hypoglycemia risk reduction, greater hepatoselectivity, lower lipotropism and the ability to alleviate deficient incretin function via the increased secretion of GLP-1 [72][73][74][75]. The data obtained in the analysis of non-pregnant patients with DM suggest new additional opportunities in the treatment of patients experiencing difficulties in controlling weight gain during pregnancy.…”