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Long-acting insulin may be more effective in treating type 1 diabetes
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Long-acting insulin analogues are safer, more effective and more cost-effective than intermediate-acting therapies for adults with type 1 diabetes, but the difference in HbA1c is minimal, according to research published in the BMJ.
In a systematic review and network meta-analysis of 39 studies, Andrea C. Tricco, PhD, of St. Michael’s Hospital in Toronto, and colleagues compared once-daily and twice-daily doses of long-acting glargine and detemir with intermediate-acting neutral protamine Hagedorn (NPH).
Andrea C. Tricco
“In patients with type 1 diabetes, we found that long-acting insulin is superior to intermediate-acting insulin when it came to controlling blood sugar, preventing weight gain and treating severe hypoglycemia,” Tricco said in a press release.
The researchers analyzed 39 studies, including 27 randomized controlled trials (RCTs) involving 7,496 patients, from 6,501 abstracts and 190 full-text articles identified through Medline, Cochrane Central Register of Controlled Trials, Embase and grey literature.
In a network meta-analysis of 26 RCTs, long-acting insulins significantly reduced HbA1c compared with NPH once daily. The mean differences (MD) were:
- Glargine once daily vs. NPH: MD, –0.39%; 95% CI, –0.59 to –0.19;
- Detemir once daily vs. NPH: MD, –0.26%; 95% CI, –0.48 to –0.03, and
- Detemir once/twice daily vs. NPH: MD, –0.36%, 95% CI, –0.65 to –0.08.
A meta-analysis of 16 RCTs demonstrated differences between long- and intermediate-acting insulin for severe hypoglycemia (detemir once/twice daily vs. NPH once/twice daily: OR=0.65; 95% CI, 0.5-0.85).
Weight gain differences were observed between long- and short-acting therapies in a meta-analysis of 13 RCTs:
- Detemir once-daily vs. NPH once/twice daily: OR=4.04 kg; 95% CI, 3.06-5.02;
- Detemir once/twice daily vs. NPH once daily: OR=–5.51 kg; 95% CI, –6.56 to –4.46; and
- Glargine once daily vs. NPH once daily: OR=–5.14 kg; 95% CI, –6.07 to –4.21.
“Those taking intermediate-acting insulin were more likely to gain weight,” Tricco said in the release “They gained an average of 4 to 6 pounds more than the participants who took most long-acting insulin doses.”
Compared with NPH, detemir was less costly and more effective in three of 14 cost-effectiveness analyses and glargine in two of eight cost-effectiveness analyses. Both detemir and glargine were more costly than NPH, yet more effective, in the remaining cost-effectiveness analyses. In a comparison of long-acting therapies, glargine was not cost-effective compared with detemir in two of two cost-effectiveness analyses.
“With this information, patients and their doctors should tailor their choice of insulin according to preference, cost and accessibility,” Tricco said.
Disclosure: The research was funded by the Drug Safety and Effectiveness Network of the Canadian Institutes of Health Research.
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