How do detemir and glargine compare when added to oral agents in insulin-näve patients with type 2 diabetes mellitus?

In this Practice Point commentary, I describe the findings and limitations of a 52-week, open-label, noninferiority, head-to-head comparison study of the basal insulin analogs detemir and glargine. Rosenstock et al. enrolled 582 insulin-näve individuals with type 2 diabetes mellitus inadequately controlled with oral antidiabetic agents. Participants were randomly allocated to receive either detemir or glargine, titrated to a target fasting plasma glucose level ≤6 mmol/l in the absence of hypoglycemia. Detemir was administered once-daily or (if needed) twice-daily to control predinner blood glucose levels, whereas glargine was administered only once-daily. Comparable improvements in glycemic control were observed in the two treatment groups. By contrast, less weight gain occurred with detemir than with glargine. Nonetheless, higher levels of detemir than glargine were required to achieve these beneficial effects and only 45% of patients in the detemir group remained on the once-daily dosing schedule. The implications of these observations for clinical practice are discussed.