TITLE

Review: long-acting insulin analogues do not improve glycaemic control but reduce nocturnal hypoglycaemia

AUTHOR(S)
Tran, K.
PUB. DATE
June 2008
SOURCE
Evidence Based Medicine;Jun2008, Vol. 13 Issue 3, p79
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
QUESTION In patients with diabetes mellitus, what is the efficacy of long acting insulin analogues (LAIAs) compared with human insulin or oral antidiabetic agents? REVIEW SCOPE Studies selected compared LAIAs (insulin glargine or insulin detemir) with conventional human insulin (including neutral protamine Hagedorn [NPH]) or oral antidiabetic agents in patients with type 1 or 2, or gestational diabetes. Outcomes included glycaemic control (haemoglobin A1c [HbA1c] concentration) and hypoglycaemic episodes. REVIEW METHODS Medline, EMBASE/Excerpta Medica, BIOSIS Previews, PASCAL, PubMed, and Cochrane Database of Systematic Reviews (1990 to February 2006); Health Economics Evaluation Database; and websites of regulatory and health technology assessment agencies and professional associations were searched for randomised controlled trials (RCTs). Drug manufacturers were also contacted. 34 RCTs met efficacy selection criteria: 14 of insulin glargine and 9 of insulin detemir in type 1 diabetes (n = 7142); 9 of insulin glargine and 2 of insulin detemir in type 2 diabetes (n = 4729). 31 trials involved adults only. Average quality of the 28 fully published RCTs was low (mean 2.3 on Jadad scale). MAIN RESULTS LAIAs and NPH did not differ for change in HbA1c concentrations (see supplementary data); results of individual trials varied, but none reported important, large differences (HbA1c reduction ⩾1%). The range of endpoint HbA1c concentrations was similar for insulin glargine v NPH (16 trials, 6.4-9.0% v 7.0-9.1%) and insulin detemir v NPH (10 trials, 6.6-8.3% v 6.5-8.4%). In type 1 diabetes, severe hypoglycaemia was reduced with insulin detemir (table) and with insulin glargine using human insulin as bolus (5 trials, relative risk reduction 27%, 95% CI 5 to 45). The table shows other main results. CONCLUSION Long acting insulin analogues do not reduce HbA1c concentrations more than NPH insulin but do reduce nocturnal hypoglycaemia.
ACCESSION #
32679418

 

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