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Prescribing Information

archived eNewsletters

Catch up on the latest developments in diabetes care.

 
 
 
June 2010 eNewsletter
Using A1C to guide the treatment
of diabetes
 
Efforts to establish a preferred diagnostic tool yield further support for the use of hemoglobin A1C in clinical practice
Clinical practice recommendations by the ADA supporting hemoglobin A1C as a diagnostic tool for diabetes were announced after years of collaborative efforts by international diabetes experts.1,2 The extensive data review that led to these recommendations yielded insights that further encourage the use of A1C values in monitoring diabetes treatment.
The use of A1C values, rather than direct measures of blood glucose, provides a number of distinct advantages, including:
•
Reliability. A1C within individuals is less variable than fasting or 2-hour postprandial blood glucose, and recent global standardization has greatly improved the reliability of the A1C assay.2-4
•
Convenience. A1C testing is easier for patients: no patient preparation is required, and patients can undergo testing at any time.2
•
Correlation to long-term risk. Strong correlations between A1C values and diabetic complications, especially retinopathy, have led to widely accepted A1C treatment goals.2,5-8
These findings, which support the 2010 ADA practice recommendations, reaffirm the importance of hemoglobin A1C. For this reason, the ADA, the AACE, and the ACE all recommend treating patients with diabetes with the goal of achieving sustained low A1C values.1,9
Learn more at NovoMedLink.com
Experts agree on
the importance of
hemoglobin A1C
 
Achieving substantial A1C reductions with Levemir®
Clinicians regularly select and recommend therapy for patients with diabetes based on documented A1C-lowering potential. That's why clinical experts like you can more confidently prescribe Levemir® (insulin detemir [rDNA origin] injection). Levemir® is a long-acting basal insulin that has been proven effective in helping patients with diabetes lower their A1C levels. In a clinical study in patients with type 2 diabetes:10
•
Patients taking Levemir® had a mean A1C reduction of 1.2% over 20 weeks in the 70-90 mg/dL group
•
64% of patients met the ADA A1C goal (<7%) in the 70-90 mg/dL group
•
The mean A1C at study end was 6.77% in the 70-90 mg/dL group
For patients taking Levemir® once daily, the dose can be adjusted to reach FPG goals: 70-90 mg/dL or 80-110 mg/dL.
Results from a 20-week, randomized, controlled, multicenter, open-label, parallel-group, treat-to-target trial using the PREDICTIVE® 303 self-titration algorithm in insulin-naive patients with type 2 diabetes, A1C ≥7% and ≤9%, on OAD therapy randomized to Levemir® and OAD (1:1) to 2 different FPG titration targets (70-90 mg/dL [n=121] or 80-110 mg/dL [n=122]).10
PREDICTIVE = Predictable Results and Experience in Diabetes through Intensification and Control to Target: an International Variability Evaluation.
Review more results of a randomized, treat-to-target study, and see why Levemir® may be right for your patients with type 2 diabetes.
 
Levemir® samples
for your practice
Request complimentary samples of Levemir®, Levemir® FlexPen®, and other Novo Nordisk diabetes care products.
 
Beyond A1C values: Levemir® and weight considerations*
While lowering A1C values is a primary treatment goal for all of your patients, for some the challenges of managing diabetes may be accompanied by concerns about weight gain. When prescribing treatment for these patients, you may want to consider the proven weight benefits of Levemir®.11,12
Watch a brief interactive video featuring diabetes expert Dr. Philis-Tsimikas and learn about clinical studies that demonstrate weight benefits with Levemir®.11,12
 
This e-mail is just one of the many resources available to registered members of NovoMedLink™.
To find even more relevant information for you and your practice, visit NovoMedLink.com. 
 
Levemir® (insulin detemir [rDNA origin] injection)
Indications and Usage
Levemir® is indicated for once- or twice-daily subcutaneous administration for the treatment of adult and pediatric patients with type 1 diabetes mellitus or adult patients with type 2 diabetes mellitus who require basal (long-acting) insulin for the control of hyperglycemia.
Levemir® Important Safety Information
Levemir® is contraindicated in patients hypersensitive to insulin detemir or one of its excipients.
Levemir® should not be diluted or mixed with any other insulin preparations.
Hypoglycemia is the most common adverse effect of all insulin therapies, including Levemir®. As with other insulins, the timing of hypoglycemic events may differ among various insulin preparations. Glucose monitoring is recommended for all patients with diabetes. Levemir® is not to be used in insulin infusion pumps. Any change of insulin dose should be made cautiously and only under medical supervision. Concomitant oral antidiabetes treatment may require adjustment. Needles and Levemir® FlexPen® must not be shared.
Needles and Levemir® FlexPen® must not be shared.
Inadequate dosing or discontinuation of treatment may lead to hyperglycemia and, in patients with type 1 diabetes, diabetic ketoacidosis. Insulin may cause sodium retention and edema, particularly if previously poor metabolic control is improved by intensified insulin therapy. Dose and timing of administration may need to be adjusted to reduce the risk of hypoglycemia in patients being switched to Levemir® from other intermediate or long-acting insulin preparations. The dose of Levemir® may need to be adjusted in patients with renal or hepatic impairment.
Other adverse events commonly associated with insulin therapy may include injection site reactions (on average, 3% to 4% of patients in clinical trials) such as lipodystrophy, redness, pain, itching, hives, swelling, and inflammation. Less common but more serious are severe cases of generalized allergy, including anaphylactic reaction, which may be life threatening.
*Whether these observed differences represent true differences in the effects of Levemir®, NPH insulin, and insulin glargine is not known, since these trials were not blinded and the protocols (eg, diet and exercise instructions and monitoring) were not specifically directed at exploring hypotheses related to weight effects of the treatments compared. The clinical significance of the observed differences in weight has not been established.
Please click here for Prescribing Information.
 
Novo Nordisk Disclaimer
These materials are provided "as is" and without warranties of any kind either express or implied. To the fullest extent permissible, pursuant to applicable law, we disclaim all warranties, express or implied, including, but not limited to, implied warranties of merchantability and fitness for a particular purpose. We do not warrant that the functions contained on any Novo Nordisk Inc. site will be uninterrupted or error-free, that defects will be corrected or that any Novo Nordisk Inc. site or the servers that make such materials available are free of viruses or other harmful components. We do not warrant or make any representations regarding the use or the results of the use of the materials on any Novo Nordisk Inc. site in terms of their correctness.
 
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References:
1. American Diabetes Association. Standards of medical care in diabetes—2009. Diabetes Care. 2009;32(suppl 1):S13-S61.
 
2. International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32(7):1327-1334.
 
3. Selvin E, Zhu H, Brancati FL. Elevated A1C in adults without a history of diabetes in the US. Diabetes Care. 2009;32(5):828-833.
 
4. Rohlfing C, Wiedmeyer HM, Little R, et al. Biological variation of glycohemoglobin. Clin Chem. 2002;48:1116-1118.
 
5. United Kingdom Prospective Diabetes Study (UKPDS). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):837-853.
 
6. van Leiden HA, Dekker JM, Moll AC. Risk factors for incident retinopathy in a diabetic and nondiabetic population: the Hoorn study. Arch Ophthalmol. 2003;121:245-251.
 
7. Tapp RJ, Tikellis G, Wong TY, Harper C, Zimmet PZ, Shaw JE. Longitudinal association of glucose metabolism with retinopathy. Diabetes Care. 2008;31:1349—1354.
 
8. Sabanayagam C, Liew G, Tai ES, et al. Relationship between glycated hemoglobin and microvascular complications: is there a natural cut-off point for the diagnosis of diabetes? Diabetologia. 2009;52(7):1279-1289.
 
9. Rodbard HW, Jellinger PS, Davidson JA, et al. Statement by an American Association of Clinical Endocrinologists/American College of Endocrinology consensus panel on type 2 diabetes mellitus: an algorithm for glycemic control. Endocr Pract. 2009;15(6):540-559.
 
10. Blonde L, Meriläinen M, Karwe V, Raskin P; for the TITRATE™ Study Group. Patient-directed titration for achieving glycaemic goals using a once-daily basal insulin analogue: an assessment of two different fasting plasma glucose targets—the TITRATE™ study. Diabetes Obes Metab. 2009;11(6):623-631.
 
11. Rosenstock J, Davies M, Home PD, Larsen J, Koenen C, Schernthaner G. A randomised, 52-week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetologia. 2008;51(3):408-416.
 
12. Hollander P, Cooper J, Bregnhøj J, Pedersen CB. A 52-week, multinational, open-label, parallel-group, noninferiority, treat-to-target trial comparing insulin detemir with insulin glargine in a basal-bolus regimen with mealtime insulin aspart in patients with type 2 diabetes. Clin Ther. 2008;30(11):1976-1987.
Novo Nordisk Inc.
100 College Road West
Princeton, NJ 08540
FlexPen® and Levemir® are registered trademarks of Novo Nordisk A/S. NovoMedLink™ is a trademark of Novo Nordisk A/S.
©2010 Novo Nordisk A/S. All rights reserved.
141334     June  2010

  1. Levemir® (insulin detemir [rDNA origin] injection) Indications and Usage

    Levemir® is indicated for once- or twice-daily subcutaneous administration for the treatment of adult and pediatric patients with type 1 diabetes mellitus or adult patients with type 2 diabetes mellitus who require basal (long-acting) insulin for the control of hyperglycemia.

    Levemir® Important Safety Information

    Levemir® is contraindicated in patients hypersensitive to insulin detemir or one of its excipients.

    Levemir® should not be diluted or mixed with any other insulin preparations.

    Hypoglycemia is the most common adverse effect of all insulin therapies, including Levemir®. As with other insulins, the timing of hypoglycemic events may differ among various insulin preparations. Glucose monitoring is recommended for all patients with diabetes. Levemir® is not to be used in insulin infusion pumps. Any change of insulin dose should be made cautiously and only under medical supervision. Concomitant oral antidiabetes treatment may require adjustment.

    Needles and Levemir® FlexPen® must not be shared.

    Inadequate dosing or discontinuation of treatment may lead to hyperglycemia and, in patients with type 1 diabetes, diabetic ketoacidosis. Insulin may cause sodium retention and edema, particularly if previously poor metabolic control is improved by intensified insulin therapy. Dose and timing of administration may need to be adjusted to reduce the risk of hypoglycemia in patients being switched to Levemir® from other intermediate or long-acting insulin preparations. The dose of Levemir® may need to be adjusted in patients with renal or hepatic impairment.

    Other adverse events commonly associated with insulin therapy may include injection site reactions (on average, 3% to 4% of patients in clinical trials) such as lipodystrophy, redness, pain, itching, hives, swelling, and inflammation. Less common but more serious are severe cases of generalized allergy, including anaphylactic reaction, which may be life threatening.

    *Whether these observed differences represent true differences in the effects of Levemir®, NPH insulin, and insulin glargine is not known since these trials were not blinded and the protocols (e.g., diet and exercise instructions and monitoring) were not specifically directed at exploring hypotheses related to weight effects of the treatments compared. The clinical significance of the observed differences in weight has not been established.

    Please see Prescribing InformationPrescribing Information.

  2. NovoLog® (insulin aspart [rDNA origin] injection) Indications and Usage

    NovoLog® is an insulin analog indicated to improve glycemic control in adults and children with diabetes mellitus.

    NovoLog® Important Safety Information

    NovoLog® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to NovoLog® or one of its excipients.

    NovoLog® has a more rapid onset and shorter duration of action than regular human insulin. An injection of NovoLog® should be immediately followed by a meal within 5 to 10 minutes. Because of the short duration of action of NovoLog®, a longer-acting insulin also should be used in patients with type 1 diabetes and may be needed in patients with type 2 diabetes. When used in an external subcutaneous insulin infusion pump, NovoLog® should not be mixed with any other insulin or diluent. Hypoglycemia is the most common adverse effect of all insulin therapies, including NovoLog®. The timing of hypoglycemia usually reflects the time-action profile of the administered insulins.

    Any change of insulin dose should be made cautiously and only under medical supervision. Glucose monitoring is recommended for all patients with diabetes and is particularly important for patients using external pump infusion therapy. As with all insulin preparations, the time course of action of NovoLog® may vary in different individuals or at different times in the same individual and is dependent on many conditions, including injection site, local blood supply, temperature, and level of physical activity.

    Needles and NovoLog® FlexPen® must not be shared.

    NovoLog® has not been studied in children with type 2 diabetes or in children with type 1 diabetes under the age of two.

    Severe, life-threatening generalized allergy, including anaphylactic reaction, may occur with any insulin product, including NovoLog®. Adverse reactions observed with NovoLog® include hypoglycemia, allergic reactions, local injection site reactions, lipodystrophy, rash, and pruritus. Insulin, particularly when given intravenously or in settings of poor glycemic control, may cause hypokalemia. Like all insulins, NovoLog® requirements may be reduced in patients with renal impairment or hepatic impairment.

    All pregnancies have a background risk of birth defects, loss, or other adverse outcome regardless of drug exposure. This background risk is increased in pregnancies complicated by hyperglycemia and may be decreased with good metabolic control. It is essential for patients with diabetes or history of gestational diabetes to maintain good metabolic control before conception and throughout pregnancy.

    Please see Prescribing InformationPrescribing Information.

  3. NovoLog® Mix 70/30 (70% insulin aspart protamine suspension and 30% insulin aspart injection, [rDNA origin]) Indications and Usage

    NovoLog® Mix 70/30 (70% insulin aspart protamine suspension and 30% insulin aspart injection, [rDNA origin]) is an insulin analog indicated to improve glycemic control in patients with diabetes mellitus.

    Important Limitations of Use:
    In premix insulins, such as NovoLog® Mix 70/30, the proportions of rapid acting and long acting insulins are fixed and do not allow for basal versus prandial dose adjustments.

    NovoLog® Mix 70/30 Important Safety Information

    NovoLog® Mix 70/30 is contraindicated during episodes of hypoglycemia and in patients hypersensitive to NovoLog® Mix 70/30 or one of its excipients.

    NovoLog® Mix 70/30 has a faster onset of action than human insulin premix 70/30 and should be dosed within 15 minutes before meal initiation for patients with type 1 diabetes. For patients with type 2 diabetes, dosing should occur within 15 minutes before or after meal initiation.

    NovoLog® Mix 70/30 should not be administered intravenously or used in insulin infusion pumps. NovoLog® Mix 70/30 should not be mixed with any other insulin product.

    Hypoglycemia is the most common adverse effect of insulin therapy, including NovoLog® Mix 70/30. The timing of hypoglycemia may reflect the time-action profile of the insulin formulation. Glucose monitoring is recommended for all patients with diabetes. Any change of insulin should be made cautiously and only under medical supervision.

    Needles and NovoLog® Mix 70/30 FlexPen® must not be shared.

    Severe, life-threatening generalized allergy, including anaphylaxis, may occur with insulin products, including NovoLog® Mix 70/30. Adverse reactions observed with NovoLog® Mix 70/30 include hypoglycemia, allergic reactions, local injection site reactions, lipodystrophy, rash, and pruritus. Insulin, particularly when given in settings of poor glycemic control, may cause hypokalemia. Like all insulins, NovoLog® Mix 70/30 requirements may be reduced in patients with renal impairment or hepatic impairment.

    The safety and effectiveness of NovoLog® Mix 70/30 has not been established in pediatric patients. Clinical studies of NovoLog® Mix 70/30 did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently than younger patients.

    Please see Prescribing InformationPrescribing Information.

  4. Victoza® (liraglutide [rDNA origin] injection) Indications and Usage

    Victoza® is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

    Because of the uncertain relevance of the rodent thyroid C-cell tumor findings to humans, prescribe Victoza® only to patients for whom the potential benefits are considered to outweigh the potential risk. Victoza® is not recommended as first-line therapy for patients who have inadequate glycemic control on diet and exercise.

    In clinical trials of Victoza®, there were more cases of pancreatitis with Victoza® than with comparators. Victoza® has not been studied sufficiently in patients with a history of pancreatitis to determine whether these patients are at increased risk for pancreatitis while using Victoza®. Use with caution in patients with a history of pancreatitis.

    Victoza® is not a substitute for insulin. Victoza® should not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis, as it would not be effective in these settings.

    The concurrent use of Victoza® and insulin has not been studied.

    Victoza® Important Safety Information

    Liraglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice. It is unknown whether Victoza® causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as human relevance could not be ruled out by clinical or nonclinical studies. Victoza® is contraindicated in patients with a personal or family history of MTC and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Based on the findings in rodents, monitoring with serum calcitonin or thyroid ultrasound was performed during clinical trials, but this may have increased the number of unnecessary thyroid surgeries. It is unknown whether monitoring with serum calcitonin or thyroid ultrasound will mitigate human risk of thyroid C-cell tumors. Patients should be counseled regarding the risk and symptoms of thyroid tumors.

    If pancreatitis is suspected, Victoza® should be discontinued. Victoza® should not be re-initiated if pancreatitis is confirmed.

    When Victoza® is used with an insulin secretagogue (e.g. a sulfonylurea) serious hypoglycemia can occur. Consider lowering the dose of the insulin secretagogue to reduce the risk of hypoglycemia.

    There have been no studies establishing conclusive evidence of macrovascular risk reduction with Victoza® or any other antidiabetic drug.

    The most common adverse reactions, reported in ≥5% of patients treated with Victoza® and more commonly than in patients treated with placebo, are headache, nausea, diarrhea, and anti-liraglutide antibody formation. Immunogenicity-related events, including urticaria, were more common among Victoza®-treated patients (0.8%) than among comparator-treated patients (0.4%) in clinical trials.

    Victoza® has not been studied in type 2 diabetes patients below 18 years of age and is not recommended for use in pediatric patients.

    Victoza® should be used with caution in patients with renal impairment and in patients with hepatic impairment.

    Please see Prescribing InformationPrescribing Information and Medication GuideMedication Guide.

FlexPen®, Levemir®, NovoLog®, and Victoza® are registered trademarks and NovoMedLink™ is a trademark of Novo Nordisk.