Comment from Vandana Raman

I am a pediatric endocrinologist . I strongly support efforts to preserve access to insulin detemir or to facilitate development of a biosimilar alternative. The concerns outlined in this petition are clinically meaningful and reflect real challenges we are already encountering in practice. In pediatric diabetes care, insulin flexibility matters greatly. Many children, adolescents, athletes, pregnant individuals, and patients with highly variable insulin sensitivity benefit from the shorter and more adjustable action profile of detemir compared with other currently available basal insulins. For some patients, transitioning to glargine or degludec has resulted in increased glycemic variability, hypoglycemia, hyperglycemia, or reduced quality of life. Detemir has also been especially important in very young children and newly diagnosed patients requiring extremely small insulin doses. The loss of this option disproportionately affects vulnerable pediatric populations. While many patients can transition successfully to alternative basal insulins, others cannot achieve the same degree of glucose stability, flexibility, or safety. Preserving therapeutic choice in insulin management is important because diabetes care is highly individualized, and patients respond differently to available basal insulin formulations. I support the advocacy for exploring regulatory pathways that would preserve access to detemir, including facilitating biosimilar development, accelerating review pathways, and working collaboratively with manufacturers to minimize disruption in patient care.