What are the effects of using insulin detemir as first-line treatment for type 2 diabetes? — KIPPE BURNETT, RN, FNP, Somerset, Ky.

The American Diabetes Association and the European Association for the Study of Diabetes released a consensus statement on the approach to the management of hyperglycemia in patients with type 2 diabetes (Diabetes Care. 2009;32:193-203). The recommendation includes intervention at the time of diagnosis with metformin in combination with lifestyle changes, which include medical nutrition therapy and exercise.

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Clinicians should monitor glycemic goals and intensify pharmacologic therapy with additional agents, including early initiation of insulin therapy, to reach a glycemic goal of hemoglobin (Hb)A1c <7% in most patients. Initiation of insulin at the time of diagnosis of type 2 diabetes is recommended for individuals presenting with weight loss or other severe hyperglycemic signs or symptoms.

According to the consensus statement, the precise drug or exact sequence may not be as important as achieving and maintaining glycemic targets safely. A study compared insulin detemir with neutral protamine hagedorn (NPH) insulin as add-on therapy to oral glucose-lowering drugs in people with type 2 diabetes (Diabetes Care. 2006;29:1269-1274). Investigators concluded that the addition of basal insulin to oral drug therapy in people with suboptimal control of type 2 diabetes achieves guideline-recommended HbA1c values in most people with aggressive titration. Compared with NPH insulin, insulin detemir achieves the same glycemic goal with reduced hypoglycemia and less weight gain. — Eileen F. Campbell, MSN, CRNP, Associate Program Director, Family Health Nurse Practitioner Program, University of Pennsylvania School of Nursing, Philadelphia (152-05)