- Consider avoiding detemir (Levemir) and possibly other albumin-bound insulins in patients with hypoalbuminemia.
Why this matters
- Despite a common belief that detemir should be avoided in hypoalbuminemic patients because they have less predictable free insulin levels, guidelines do not address this.
- Retrospective analysis of data for 4677 inpatients, including 82.2% treated with glargine (Lantus) and 17.8% with detemir.
- Multivariable model used to correct for baseline differences between glargine and detemir groups.
- Funding: None.
- Rates of glucose <70 mg/dL within 2 days of minimal albumin level were 16.8% with glargine, 20.9% with detemir (P<.05); rates of glucose <54 mg/dL were 6.3% and 8.4%, respectively (P<.05).
- Detemir treatment increased hypoglycemia risk by 35%.
- Minimal albumin level was negatively associated with hypoglycemia (OR, 0.68; 95% CI, 0.58-0.80): for 1 g/dL decrease in minimal albumin, hypoglycemia increased by 32%, with similar results for glucose <54 mg/dL.
- Glargine-treated patients had lower minimal albumin levels (2.6 vs 2.8 g/dL; P<.0001), suggesting that physicians tend to avoid detemir in hypoalbuminemia.
- Significant difference in hypoglycemia seen between the 2 insulins in patients with albumin ≤3 g/dL but no difference with albumin >3 g/dL.
- Retrospective design.
- Unavoidable differences between glargine and detemir groups.