Differential effects of adiposity on pharmacodynamics of basal insulins NPH, glargine, and detemir in type 2 diabetes mellitus

Diabetes Care. 2011 Dec;34(12):2521-3. doi: 10.2337/dc11-1064. Epub 2011 Oct 4.


Objective: To assess the role of adiposity on the pharmacodynamics of basal insulins NPH, detemir, and glargine in type 2 diabetes mellitus (T2DM), as estimated by glucose infusion rate (GIR) and endogenous glucose production (EGP) rate in the euglycemic clamp.

Research design and methods: We examined the variables that best predicted GIR and EGP in 32-h clamp studies after treatment with subcutaneous injection of 0.4 units/kg NPH, detemir, and glargine in 18 T2DM subjects (crossover).

Results: A multiple regression analysis revealed that BMI best predicted GIR variation during the clamp. BMI was inversely correlated with GIR in all three insulin treatments, but was statistically significant in detemir treatment only. BMI correlated positively with residual suppression of EGP in detemir, but not with glargine and NPH treatments.

Conclusions: Adiposity blunts the pharmacodynamics of all basal insulins in T2DM. However, as adiposity increases, the effect of detemir is lower versus NPH and glargine.

MeSH terms

  • Adiposity*
  • Aged
  • Blood Glucose / drug effects
  • Body Mass Index
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Female
  • Glucose Clamp Technique
  • Humans
  • Hypoglycemic Agents / administration & dosage*
  • Hypoglycemic Agents / therapeutic use
  • Injections, Subcutaneous
  • Insulin Detemir
  • Insulin Glargine
  • Insulin, Isophane / administration & dosage*
  • Insulin, Isophane / therapeutic use
  • Insulin, Long-Acting / administration & dosage*
  • Insulin, Long-Acting / therapeutic use
  • Male
  • Middle Aged


  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin, Long-Acting
  • Insulin Glargine
  • Insulin Detemir
  • Insulin, Isophane