Insulin detemir may raise hypoglycemia risk in patients with hypoalbuminemia

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Takeaway

  • 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.

Study design

  • 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.

Key results

  • Rates of glucose
  • 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
  • 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.

Limitations

  • Retrospective design.
  • Unavoidable differences between glargine and detemir groups.