Studies cover broad areas

The 50 Novo Nordisk presentations included studies focusing on oral antidiabetic drugs (OADs), new insulin delivery devices and inhaled insulin therapy. Abstracts
of the presentations are available on www.novonordisk.com/investors under ‘Conferences / Abstracts’.

When a person with Type 2 diabetes first begins insulin therapy, his or her preferences for a delivery device are central to good treatment compliance, which in turn is critical to reducing the risk of complications. One of the studies presented¹ showed that people with Type 2 diabetes prefer the combination of NovoLog^® Mix 70/30 with the new FlexPen^® delivery device over the Humalog^® Mix 75/25™ Pen, another commonly prescribed device, for overall ease of use by more than
8 to 1. Approximately 75% of participants preferred to continue with NovoLog^® Mix 70/30 FlexPen^® after the trial compared to 14.3% preferring to con­tinue with Humalog^® Mix 75/25™ Pen. 

A study in people with Type 1 diabetes showed that insulin aspart (rDNA origin) injection (called NovoLog^® in the United States and NovoRapid^® in Europe), a rapid-acting human insulin analogue, maintains adequate post-meal glycaemic control whether administered just before or after the meal.² The findings are important because people with Type 1 diabetes need to calculate an insulin dose based on the amount of carbohydrate to be consumed in a meal, which is often difficult to know or plan a half-hour before the meal, as is recommended with regular human insulin. Ad­ministering insulin aspart right after a meal, when the amount of carbohydrate consumed is known, permits more accurate and flexible dosing. 

While various types of long-acting or basal insulin products are currently available, such as NPH insulin, there is a need for one that delivers a more reproducible supply of insulin and which people with diabetes can rely on to control blood glucose, especially overnight. New clinical trial data³ suggests that the soluble basal insulin analogue, insulin detemir, may provide more consistent, long-lasting control of blood glucose levels between meals and overnight compared to the traditionally used NPH insulin. Researchers showed that, compared to NPH insulin, insulin detemir had a flatter, less variable and more predictable pharmacodynamic profile – desirable characteristics for basal insulin therapy. Currently undergoing Phase 3 trials, insulin detemir has a unique mechanism of action that allows it to be released into the bloodstream at a slow, consistent rate.

New findings in people with Type 2 diabetes show that the OAD repaglinide (called Prandin^® in the United States, NovoNorm^® in Europe and GlucoNorm^® in Canada) improves the control of blood glucose more effectively than nateglinide (Starlix^®, Novartis), when either OAD is taken alone or in combination with metformin,⁴ another OAD, that increases the body’s sensitivity to insulin. 

The development of inhaled insulin therapy, which would circumvent the need for insulin injections, has been a holy grail in diabetes research for more than 80 years, and the challenges have been formidable. For example, delivering a consistent amount of insulin into the lungs is difficult given variations of inhaling, even for the same individual.

A new study,⁵ sponsored by Novo Nordisk and its partner, Aradigm Corporation, showed that insulin administered via an electronic inhaled insulin system called the AERx^® insulin Diabetes Manage­ment System (iDMS) achieves a level of blood glucose control (glycaemic control) in people with Type 2 diabetes comparable to the current gold standard of multiple injection therapy. All participants in the study also administered bedtime injections of NPH insulin. The results are important because, while intensive glycaemic control is essential to reducing the risk of long-term complications of Type 26 as well as Type 17 diabetes, multiple insulin injections can be inconvenient and a burden to many patients. The new findings show that mealtime insulin can be delivered via the AERx^® iDMS without the need to compromise on glycaemic control. 

¹ Vora JP, Nygaard-Pedersen L, Erichsen K, Hansen AB, Niskanen L. Patients with type 2 diabetes using biphasic insulin analog prefer NovMix 30 FlexPen to the HumaLog Mix 75/25 Pen. Poster 546, presented at: American Diabetes Association annual meeting, San Francisco, CA, June 15, 2002. - 2 Jovanovic L and Pettitt DJ. Postprandial glycemic control is provided by either preprandial or postprandial administration of insulin aspart in type 1 diabetes. Poster 415, presented at: American Diabetes Association annual meeting, San Francisco, CA, June 15, 2002. - 3Pieber TR, Plank J, Goerzer E, Sommer R, Wutte A, Sinner F, Bodenlenz M, Endahl L, Draeger E, Zdravkovic M. – Duration of action, pharmacodynamic profile and between-subject variability of insulin detemir in subjects with type 1 diabetes. Oral presentation 214, presented at: American Diabetes Association annual meeting, San Francisco, CA, June 17, 2002. - 4 Saad MF, Hale P, Khutoryansky N. Efficacy of repaglinide vs. nateglinide: as monotherapy or metformin combination therapy. Poster 536, presented at: American Diabetes Association annual meeting, San Fran­cisco, CA, June 15, 2002. - 5 Hermansen K, Ronnemaa T, Petersen AH, Adamson U. Intensive Treatment with Pulmonary Insulin using the AERx^® insulin Diabetes Management System – A Proof of Concept Trial in Type 2 Diabetic Patients. Oral presentation 194, presented at: American Dia­betes Association annual meeting, San Francisco, CA, June 16, 2002. - 6 UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with Type 2 diabetes (UKPDS 33). Lancet 1998; 352;9131: 837-53. - 7 The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. NEJM 1993; 329:977–86.