***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Insulin detemir is a soluble long-acting basal insulin analog design ed to overcome the limitations of conventional basal insulin formulations . Accordingly , insulin detemir has been compared with NPH insulin with respect to glycemic control ( HbA1c , prebreakfast glucose levels and variability , and hypoglycemia ) and timing of administration . RESEARCH DESIGN AND METHODS People with type 1 diabetes ( n = 408 ) were r and omized in an open-label , parallel-group trial of 16-week treatment duration using either insulin detemir or NPH insulin . Insulin detemir was administered twice daily using two different regimens , either before breakfast and at bedtime ( IDet(morn+bed ) ) or at a 12-h interval ( IDet(12h ) ) . NPH insulin was administered before breakfast and at bedtime . Mealtime insulin was given as the rapid-acting insulin analog insulin aspart . RESULTS With both insulin detemir groups , clinic fasting plasma glucose was lower than with NPH insulin ( IDet(12h ) vs. NPH , -1.5 mmol/l [ 95 % CI -2.51 to -0.48 ] , P = 0.004 ; IDet(morn+bed ) vs. NPH , -2.3 mmol/l ( -3.32 to -1.29 ) , P < 0.001 ) , as was self-measured prebreakfast plasma glucose ( P = 0.006 and P = 0.004 , respectively ) . The risk of minor hypoglycemia was lower in both insulin detemir groups ( 25 % , P = 0.046 ; 32 % , P = 0.002 ; respectively ) compared with NPH insulin in the last 12 weeks of treatment , this being mainly attributable to a 53 % reduction in nocturnal hypoglycemia in the IDet(morn+bed ) group ( P < 0.001 ) . Although HbA1c for each insulin detemir group was not different from the NPH group , HbA1c for the pooled insulin detemir groups was significantly lower than for the NPH group ( mean difference -0.18 % [ -0.34 to -0.02 ] , P = 0.027 ) . Within-person between-day variation in self-measured prebreakfast plasma glucose was lower for both detemir groups ( both P < 0.001 ) . The  NPH  group gained weight during the study , but there was no change in weight in either of the insulin detemir groups ( IDet(12h ) vs. NPH , -0.8 kg [ -1.44 to -0.24 ] , P = 0.006 ; IDet(morn+bed ) vs. NPH , -0.6 kg [ -1.23 to -0.03 ] , P = 0.040 ) . CONCLUSIONS Overall glycemic control with insulin detemir was improved compared with NPH insulin . The data provide a basis for tailoring the timing of administration of insulin detemir to the individual person 's needs Abstract Objectives : The aim of this analysis was to evaluate the long-term clinical and economic outcomes associated with insulin detemir and neutral protamine Hagedorn ( NPH ) insulin in combination with mealtime insulin aspart in patients with type 1 diabetes in Belgian , French , German , Italian and Spanish setting s. Methods : The published and vali date d IMS CORE Diabetes Model was used to make long-term projections of life expectancy , quality -adjusted life expectancy and direct medical costs . The analysis was based on patient characteristics and treatment effects from a 2-year r and omised controlled trial . Events were projected for a time horizon of 50 years . Potential uncertainty using a modelling approach was addressed . Results : Basal-bolus therapy with insulin detemir was projected to improve quality -adjusted life expectancy by 0.45 years versus NPH in the German setting , with similar improvements in the other countries . Insulin detemir was associated with cost savings in Belgium , Germany and Spain . In France and Italy , lifetime costs were slightly higher in the detemir arm , leading to incremental cost-effectiveness ratios of € 519 per QALY gained and € 3,256 per QALY gained , respectively . Conclusions : Compared to NPH , insulin detemir is likely to be a dominant treatment strategy in Belgium , Germany and Spain and highly cost-effective in France and Italy in patients with type 1 diabetes OBJECTIVE The primary study objective was to determine whether insulin detemir ( detemir ) was noninferior to insulin glargine ( glargine ) as the basal insulin in a basal-bolus regimen , with insulin aspart as the mealtime insulin , in terms of glycemic control at the end of 52 weeks in patients with type 1 diabetes mellitus ( T1DM ) . METHODS This multinational , open-label , parallel-group , treat-to-target , noninferiority trial enrolled patients aged > or = 18 years who had had T1DM for at least 12 months , had been taking a basal-bolus insulin regimen for at least 3 months , and had a glycosylated hemoglobin ( HbA1c ) value < or = 11.0 % at screening . Patients were r and omized in a 2:1 ratio to receive either detemir or glargine for 52 weeks . The basal insulin was initially administered once daily ( in the evening ) in both groups ; if patients in the detemir group were achieving the plasma glucose ( PG ) target before breakfast but not before dinner , they were switched to twice-daily administration . Glargine was administered once daily throughout the trial , according to its approved labeling . Each patient attended 13 study visits and received 16 scheduled telephone calls from the trial site . The primary efficacy end point was glycemic control ( HbA1c ) after 52 weeks of treatment . Secondary end points included the number of patients achieving an HbA1c value < or = 7.0 % , with or without a major hypoglycemic episode in the last month of treatment ; fasting PG ( FPG ) ; within-patient variation in self-monitored plasma glucose ( SMPG ) before breakfast and dinner ; and 10-point SMPG profiles . The noninferiority margin was 0.4 % , consistent with US Food and Drug Administration guidelines . RESULTS Four hundred forty-three patients ( mean [ SD ] age , 42 [ 12 ] years ; body mass index , 26.5 [ 4.0 ] kg/m2 ; duration of diabetes , 17.2 [ 11.4 ] years ; HbA1c , 8.1 % [ 1.1 % ] ) received study treatment . After 52 weeks , the estimated mean HbA1c did not differ significantly between the detemir and glargine groups ( 7.57 % and 7.56 % , respectively ; mean difference , 0.01 % ; 95 % CI , -0.13 to 0.16 ) , consistent with the noninferiority of detemir to glargine . The corresponding estimated changes in HbA1c were -0.53 % and -0.54 % . In the 90 patients who completed the trial on once-daily  detemir and the 173 patients who completed the trial on twice-daily  detemir , the estimated changes in HbA1c were -0.49 % and -0.58 % , respectively . After 52 weeks , there were no significant differences in the proportions of those receiving detemir and glargine who achieved an HbA1c value < or = 7.0 % without major hypoglycemia ( 31.9 % and 28.9 % , respectively ) . In addition , there were no significant differences in estimated mean FPG ( 8.58 and 8.81 mmol/L ; mean difference , -0.23 mmol/L ; 95 % CI , -1.04 to 0.58 ) or in basal insulin doses . The basal insulin dose was numerically higher in patients receiving detemir twice rather than once daily ( 0.47 vs 0.33 U/kg , respectively ) . The relative risks for total and nocturnal hypoglycemia with detemir versus glargine were 0.94 and 1.12 , respectively ( both , P = NS ) . Six patients ( 2.0 % ) r and omized to the detemir group and 4 ( 2.7 % ) r and omized to the glargine group withdrew due to adverse events . CONCLUSIONS During 52 weeks of basal-bolus therapy in patients with T1DM , detemir was noninferior to glargine in terms of overall glycemic control ( HbA1c ) . When used according to the approved labeling , detemir and glargine did not differ in tolerability or in terms of the occurrence of hypoglycemia This treat‐to‐target study compared the efficacy and safety of insulin detemir ( IDet ) and insulin glargine ( IGla ) in a basal‐bolus ( insulin aspart ) regimen in type 2 diabetes Aims /hypothesisThis 52-week multinational , r and omised , open-label , parallel-group , non-inferiority trial compared clinical outcomes following supplementation of oral glucose-lowering drugs with basal insulin analogues detemir and glargine in type 2 diabetic patients . Methods Insulin-naive adults ( n = 582 , HbA1c 7.5–10.0 % , BMI ≤ 40.0 kg/m2 ) were r and omised 1:1 to receive insulin detemir or glargine once daily ( evening ) actively titrated to target fasting plasma glucose ( FPG ) ≤ 6.0 mmol/l . An additional morning insulin detemir dose was permitted if pre-dinner plasma glucose ( PG ) was > 7.0 mmol/l after achieving FPG < 7.0 mmol/l . Due to labelling restrictions , no second glargine dose was allowed . Results Baseline HbA1c decreased from 8.6 to 7.2 and 7.1 % ( NS ) with detemir and glargine , respectively . FPG improved from 10.8 to 7.1 and 7.0 mmol/l ( NS ) , respectively . With detemir , 45 % of participants completed the study on once daily dosing and 55 % on twice daily dosing , with no difference in HbA1c . Overall , 52 % of participants achieved HbA1c ≤ 7.0 % : 33 % ( detemir ) and 35 % ( glargine ) without hypoglycaemia . Within-participant variability for self-monitored FPG and pre-dinner PG did not differ by insulin treatment , nor did the relative risk of overall or nocturnal hypoglycaemia . Modest reductions in weight gain were seen with detemir vs glargine in completers ( 3.0 vs 3.9 kg , p = 0.01 ) and in the intention-to-treat population ( 2.7 vs 3.5 kg , p = 0.03 ) , primarily related to completers on once-daily detemir . Mean daily detemir dose was higher ( 0.78 U/kg [ 0.52 with once daily dosing , 1.00 U/kg with twice daily dosing ] ) than glargine ( 0.44 IU/kg ) . Injection site reactions were more frequent with detemir ( 4.5 vs 1.4 % ) . Conclusions /interpretationSupplementation of oral agents with detemir or glargine achieves clinical ly important improvements in glycaemic control with low risk of hypoglycaemia . Non-inferiority was demonstrated for detemir using higher insulin doses ( mainly patients on twice daily dosing ) ; weight gain was somewhat reduced with once daily insulin detemir . Clinical Trials.gov ID no. : NCT00283751 OBJECTIVE To determine whether glargine is noninferior to detemir regarding the percentage of patients reaching A1C < 7 % without symptomatic hypoglycemia ≤3.1 mmol/l . RESEARCH DESIGN AND METHODS In this 24-week trial , 973 insulin-naive type 2 diabetic patients on stable oral glucose-lowering drugs with A1C 7.0–10.5 % were r and omized to glargine once daily or detemir twice daily . Insulin doses were systematic ally titrated . RESULTS 27.5 and 25.6 % of patients reached the primary outcome with glargine and detemir , respectively , demonstrating the noninferiority of glargine . Improvements in A1C were −1.46 ± 1.09 % for glargine and −1.54 ± 1.11 % for detemir ( P = 0.149 ) , with similar proportions of patients achieving A1C < 7 % ( P = 0.254 ) but more detemir-treated patients reaching A1C < 6.5 % ( P = 0.017 ) . Hypoglycemia risk was similar . Weight gain was higher for glargine ( difference : 0.77 kg , P < 0.001 ) . Glargine doses were lower than detemir doses : 43.5 ± 29.0 vs. 76.5 ± 50.5 units/day ( P < 0.001 ) . CONCLUSIONS In insulin 
    Output:
    
The evidence suggests that IDet is cost effective versus neutral protamine Hagedorn and at least as cost effective as insulin glargine in the treatment of patients with suboptimally controlled Type 1 and Type 2 diabetes