Clinician Article
Safety, effectiveness, and cost effectiveness of long acting versus intermediate acting insulin for patients with type 1 diabetes: systematic review and network meta-analysis.
PMID: 25274009
-
EndocrineRelevance - 6/7
Newsworthiness - 6/7 -
Internal MedicineRelevance - 5/7
Newsworthiness - 5/7 -
Family Medicine (FM)/General Practice (GP)Relevance - 5/7
Newsworthiness - 4/7 -
General Internal Medicine-Primary Care(US)Relevance - 5/7
Newsworthiness - 4/7
Abstract
OBJECTIVE: To examine the safety, effectiveness, and cost effectiveness of long acting insulin for type 1 diabetes.
DESIGN: Systematic review and network meta-analysis.
DATA SOURCES: Medline, Cochrane Central Register of Controlled Trials, Embase, and grey literature were searched through January 2013.
STUDY SELECTION: Randomized controlled trials or non-randomized studies of long acting (glargine, detemir) and intermediate acting (neutral protamine Hagedorn (NPH), lente) insulin for adults with type 1 diabetes were included.
RESULTS: 39 studies (27 randomized controlled trials including 7496 patients) were included after screening of 6501 titles/abstracts and 190 full text articles. Glargine once daily, detemir once daily, and detemir once/twice daily significantly reduced hemoglobin A1c compared with NPH once daily in network meta-analysis (26 randomized controlled trials, mean difference -0.39%, 95% confidence interval -0.59% to -0.19%; -0.26%, -0.48% to -0.03%; and -0.36%, -0.65% to -0.08%; respectively). Differences in network meta-analysis were observed between long acting and intermediate acting insulin for severe hypoglycemia (16 randomized controlled trials; detemir once/twice daily versus NPH once/twice daily: odds ratio 0.62, 95% confidence interval 0.42 to 0.91) and weight gain (13 randomized controlled trials; detemir once daily versus NPH once/twice daily: mean difference 4.04 kg, 3.06 to 5.02 kg; detemir once/twice daily versus NPH once daily: -5.51 kg, -6.56 to -4.46 kg; glargine once daily versus NPH once daily: -5.14 kg, -6.07 to -4.21). Compared with NPH, detemir was less costly and more effective in 3/14 cost effectiveness analyses and glargine was less costly and more effective in 2/8 cost effectiveness analyses. The remaining cost effectiveness analyses found that detemir and glargine were more costly but more effective than NPH. Glargine was not cost effective compared with detemir in 2/2 cost effectiveness analyses.
CONCLUSIONS: Long acting insulin analogs are probably superior to intermediate acting insulin analogs, although the difference is small for hemoglobin A1c. Patients and their physicians should tailor their choice of insulin according to preference, cost, and accessibility.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42013003610.
Clinical Comments
General Internal Medicine-Primary Care(US)
This latest and more complete evidence of insulin effectiveness in type 1 diabetes suggest that long acting insulin analogs are slightly superior to intermediate acting insulin analogs for hemoglobin A1c (without approaching the accepted 0.5% minimal clinically important difference), weight gain and hypoglycemia. Although the cost effectiveness analysis results were inconsistent across studies, many of them found that long acting insulin analogs were more costly and more effective than intermediate insulin analogs. However given the various shortcomings of the included studies, the clinical implications of using long acting insulin analogs remains a consensus choice between patient and physician.
Register for free access to all Professional content
RegisterOur Content
About
Support for the Portal is largely provided by the Labarge Optimal Aging Initiative. AGE-WELL is a contributing partner. Help us to continue to provide direct and easy access to evidence-based information on health and social conditions to help you stay healthy, active and engaged as you grow older. Donate Today.
