Insulin Detemir
| Evidence Level: L5 | Predicted Indications: 9 |
Table of Contents
Insulin Detemir: Autoimmune oophoritis
One-Sentence Summary
Insulin detemir is a long-acting basal insulin analogue, originally used to treat diabetes mellitus and diabetic ketoacidosis. The TxGNN model predicts it for autoimmune oophoritis, with 40 clinical trials and 20 publications compiled for this direction. Type 1 diabetes is an established, on-label use of this drug, so this result confirms existing use rather than a new repurposing opportunity.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Not recorded in the local data |
| Predicted New Indication | Autoimmune oophoritis |
| TxGNN Prediction Score | 0.9967 |
| Evidence Level | L5 |
| Canada Market Status | Approved but not marketed (approvals on record: 1) |
| Number of DINs | 1 (marketed: 0) |
| Recommended Decision | Proceed with Guardrails |
Why is This Prediction Reasonable?
Detailed mechanism-of-action data is not available in the data compiled for this report. Based on published reviews, insulin detemir is a soluble, long-acting human insulin analogue. A 14-carbon fatty acid (myristic acid) is attached to the molecule, which lets it bind reversibly to albumin. This gives slow absorption and a prolonged, more predictable glucose-lowering effect of up to 24 hours. It acts through the insulin receptor.
Type 1 diabetes is a disease of insulin deficiency, so basal insulin replacement is the standard of care. The original indication (diabetes mellitus) already covers this condition. The high TxGNN score is consistent with the drug’s known pharmacology, but it should be read as confirmation of existing use, not as a new repurposing claim.
Clinical Trial Evidence
The compiled data lists 40 trials. The most relevant ones are shown below, ordered by relevance and study design.
| Trial Number | Phase | Status | Enrollment | Key Findings |
|---|---|---|---|---|
| NCT00595374 | Phase 3 | Completed | 114 | Detemir + aspart vs NPH + aspart in adults with T1D; efficacy and safety on blood glucose control |
| NCT00447382 | Phase 3 | Completed | 330 | 12-month double-blind safety and efficacy comparison of detemir from two manufacturing processes in T1D |
| NCT00312156 | Phase 3 | Completed | 347 | Detemir vs NPH insulin in children and adolescents with T1D |
| NCT00184639 | Phase 3 | Completed | 71 | 32-week comparison of detemir and Semilente MC insulin in patients aged 6–21 with T1D |
| NCT00978627 | Phase 3 | Completed | 548 | Degludec/aspart (IDegAsp) vs detemir + aspart in T1D, with extension |
| NCT01835431 | Phase 3 | Completed | 362 | Degludec/aspart vs detemir plus mealtime aspart in children and adolescents with T1D |
| NCT00117780 | Phase 4 | Completed | 520 | Detemir once vs twice daily in a basal-bolus regimen in T1D |
| NCT01542463 | N/A | Completed | 4,464 | Large non-interventional study of safety, glycaemic control and weight in T1D/T2D |
| NCT00322257 | Phase 3 | Terminated | 596 | Inhaled vs injected mealtime insulin, both with detemir as background basal insulin; early termination limits interpretation |
| NCT01440439 | Phase 4 | Unknown | 30 | Detemir vs glargine on glycaemic control during exercise in T1D |
Several other Phase 3 trials (for example NCT01709929 and NCT01831765) used detemir as a safety study subject or as a background basal insulin. The remaining trials are mostly small pharmacokinetic studies or large observational safety studies.
Literature Evidence
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 36623517 | 2023 | RCT | Lancet Diabetes Endocrinol | EXPECT: non-inferiority trial of degludec vs detemir, both with aspart, in pregnant women with T1D |
| 33662147 | 2021 | Cochrane systematic review | Cochrane Database Syst Rev | Ultra-long-acting insulin analogues in T1D, focusing on complications and hypoglycaemia |
| 23243636 | 2012 | Systematic review | Drugs Today (Barc) | Insulin analogues, including detemir, for children and adolescents with T1D |
| 21878861 | 2011 | Meta-analysis | Pol Arch Med Wewn | Detemir vs NPH insulin in T1D |
| 29477399 | 2018 | Network meta-analysis | Value Health | Relative efficacy and safety of basal insulin regimens in adults with T1D |
| 36763996 | 2022 | Meta-analysis | Clin Ther | Degludec vs other long-acting analogues (including detemir) in T1D and T2D |
| 17326333 | 2006 | Review | Vasc Health Risk Manag | Detemir has a less variable pharmacokinetic profile than NPH and can reduce hypoglycaemia risk |
| 15516157 | 2004 | Review | Drugs | More predictable and consistent effect than NPH, with up to 24 hours of action |
| 20539842 | 2010 | Review | Vasc Health Risk Manag | Update on detemir as a basal analogue for T1D and T2D |
| 17881328 | 2007 | Pharmacology review | Endocrinol Metab Clin North Am | Molecular properties and pharmacodynamics of detemir |
Canada Market Information
| DIN | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| 02271842 | LEVEMIR PENFILL | Not specified | Not specified |
Safety Considerations
Drug Interactions: The interaction screening returned 100 interactions in total. The first 20 returned were mostly Moderate, with a few Minor. Examples of Moderate interactions:
- Other glucose-lowering drugs: metformin, pioglitazone, alogliptin, albiglutide
- Sympathomimetics and β-agonists: epinephrine, phenylephrine, pseudoephedrine, salbutamol, formoterol
- β-blocker: acebutolol
- Hormones and corticosteroids: ethinylestradiol, estradiol, hydrocortisone
- Others: acetazolamide, hydrochlorothiazide, doxycycline, alpelisib, ethanol
Topical corticosteroids (hydrocortisone, alclometasone) are rated Minor.
Other Considerations:
- Standard monitoring for hypoglycaemia and weight change applies.
- Localized lipodystrophy at injection sites is a known adverse effect of injected insulin (the model also predicted it among its lower-ranked results), although detemir is reported to carry a relatively low risk.
Please refer to the package insert for warnings and contraindications.
Conclusion and Next Steps
Decision: Proceed with Guardrails
Rationale: Several completed Phase 3 trials and multiple systematic reviews and meta-analyses support insulin detemir in type 1 diabetes. This is an existing use, so the recommendation confirms current use and does not represent a new repurposing finding.
To proceed, the following is needed:
- Package insert warnings and contraindications from Health Canada (the data compiled for this report does not include them)
- Mechanism-of-action data from DrugBank
- Dosage form and approved indication text for the Canadian licence (DIN 02271842)
- Review of the other nine predictions: none has trial or literature support. Pancreatic agenesis is mechanistically plausible, so it is best treated as a research question. The rest, including autoimmune oophoritis, opsismodysplasia and stiff person syndromes, are likely TxGNN model (deep learning) artifacts or comorbidity associations and should stay on Hold.
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.