In this episode, I’ll discuss converting inpatients from insulin glargine 300 units/mL to insulin detemir 100 units/mL without causing hypoglycemia.
A 3-month study comparing insulin glargine 300 units/mL (glargine300) to insulin detemir 100 units/mL (detemir100) found that to achieve similar glucose control, with glargine300 needing a roughly 0.07 units per kg higher dose to achieve similar outcomes. This matches previous pharmacodynamic studies that have shown a 17% lower 24 hour plasma insulin exposure with glargine300 when give as an equivalent dose to detemir100.
This means that glargine300 is less potent than detemir100, and if a 1:1 conversion from glargine300 was made to detemir100, many patients might experience hypoglycemia. That is exactly what one health system found when they retrospectively looked at inpatients who received a 1:1 dose conversion from outpatient glargine300 to inpatient detemir100 – hypoglycemia rates were doubled from about 18% to 36%.
As a result, this same health system implemented an automatic dose reduction of at least 20% when converting from glargine300 to detemir100 and published the results comparing before and after implementing this protocol in AJHP.
The primary endpoint was the incidence of hypoglycemia before and after protocol implementation. A total of 128 preprotocol and 156 postprotocol patients were analyzed. The incidence of hypoglycemia was significantly lower in the postprotocol arm than in the preprotocol arm at 11.9% vs 24.7%. For each percent reduction from glargine300 to detemir100, the likelihood of hypoglycemia was reduced by 5.3%.
The authors concluded:
A protocol requiring a minimum 20% dose reduction from iGlar300 to inpatient iDet100 reduced the incidence of hypoglycemia. Health systems should consider adopting a similar approach to reduce the occurrence of hypoglycemia upon interchange.
At the time of publication of this episode, prescribing information does not give conversion advice for transitioning between glargine300 and detemir100. Since many hospitals may only have detemir100 as the formulary equivalent, this article provides support for automatic dose conversion protocols that should achieve lower rates of hypoglycemia when switching from glargine300 to detemir100.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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