Efficacy and safety of insulin analogues for the management of diabetes mellitus: a meta-analysis

Singh, Sumeet R.; Ahmad, Fida; Lal, Avtar; Changhua Yu; Bai, Zemin; Bennett, Heather
February 2009
CMAJ: Canadian Medical Association Journal;2/17/2009, Vol. 180 Issue 4, p385
Academic Journal
Background: Although insulin analogues are commonly prescribed for the management of diabetes mellitus, there is uncertainty regarding their optimal use. We conducted meta analyses to compare the outcomes of insulin analogues with conventional insulins in the treatment of type 1, type 2 and gestational diabetes. Methods: We updated 2 earlier systematic reviews of the efficacy and safety of rapid- and long-acting insulin analogues. We searched electronic databases, conference proceedings and "grey literature" up to April 2007 to identify randomized controlled trials that compared insulin analogues with conventional insulins. Study populations of interest were people with type 1 and type 2 diabetes (adult and pediatric) and women with gestational diabetes. Results: We included 68 randomized controlled trials in the analysis of rapid-acting insulin analogues and 49 in the analysis of long-acting insulin analogues. Most of the studies were of short to medium duration and of low quality. In terms of hemoglobin A[sub1c], we found minimal differences between rapid-acting insulin analogues and regular human insulin in adults with type 1 diabetes (weighted mean difference for insulin lispro: -0.09%, 95% confidence interval [CI] 0.16% to -0.02%; for insulin aspart: -0.13%, 95% CI -0.20% to -0.07%). We observed similar outcomes among patients with type 2 diabetes (weighted mean difference for insulin lispro: -0.03%, 95% CI -0.12% to -0.06%; for insulin aspart: -0.09%, 95% CI -0.21% to 0.04%). Differences between long-acting insulin analogues and neutral protamine Hagedorn insulin in terms of hemoglobin A1c were marginal among adults with type 1 diabetes (weighted mean difference for insulin glargine: -0.11%, 95% CI -0.21% to -0.02%; for insulin detemir: -0.06%, 95% CI -0.13% to 0.02%) and among adults with type 2 diabetes (weighted mean difference for insulin glargine: -0.05%, 95% CI -0.13% to 0.04%; for insulin detemir: 0.13%, 95% CI 0.03% to 0.22%). Benefits in terms of reduced hypoglycemia were inconsistent. There were insufficient data to determine whether insulin analogues are better than conventional insulins in reducing longterm diabetes-related complications or death. Interpretation: Rapid- and long-acting insulin analogues offer little benefit relative to conventional insulins in terms of glycemic control or reduced hypoglycemia. Long-term, high quality studies are needed to determine whether insulin analogues reduce the risk of long term complications of diabetes.


Related Articles

  • Cost-effectiveness of insulin analogues for diabetes mellitus. Cameron, Chris G.; Bennett, Heather A. // CMAJ: Canadian Medical Association Journal;2/17/2009, Vol. 180 Issue 4, p400 

    Background: Insulin analogues may be associated with fewer episodes of hypoglycemia than conventional insulins. However, they are costly alternatives. We compared the cost-effectiveness of insulin analogues and conventional insulins used to treat type 1 and type 2 diabetes mellitus in adults....

  • Pioglitazone Reduces Atherogenic Dense LDL Particles in Nondiabetic Patients With Arterial Hypertension. Winkler, Karl; Konrad, Thomas; Füllert, Stefanie; Friedrich, Isolde; Destani, Ramadan; Baumstark, Manfred W.; Krebs, Kristin; Wieland, Heinrich; März, Winfried // Diabetes Care;Sep2003, Vol. 26 Issue 9, p2588 

    OBJECTIVE — The oral antidiabetic agent pioglitazone improves insulin sensitivity and glycemic control and appears to lower atherogenic dense LDL in type 2 diabetes. Insulin resistance may occur frequently in nondiabetic patients with hypertension. This study is the first to report the...

  • Effects of Glycemic Control on Prevalence of Diabetic Frozen Shoulder. Yian, Edward H.; Contreras, Richard; Sodl, Jeffrey F. // Journal of Bone & Joint Surgery, American Volume;5/16/2012, Vol. 94-A Issue 10, p919 

    Background: There is controversy regarding the influence of glycemic control in diabetic patients with frozen shoulder. To determine the relationship between glycemic control and the prevalence of frozen shoulder in diabetic patients, we hypothesized that increased glycosylated hemoglobin Alc...

  • Serum Glycated Albumin to Guide the Diagnosis of Diabetes Mellitus. Wu, Wan-Chen; Ma, Wen-Ya; Wei, Jung-Nan; Yu, Tse-Ya; Lin, Mao-Shin; Shih, Shyang-Rong; Hua, Cyue-Huei; Liao, Ying-Jhu; Chuang, Lee-Ming; Li, Hung-Yuan // PLoS ONE;1/14/2016, Vol. 11 Issue 1, p1 

    In the diagnosis of diabetes mellitus, hemoglobin A1c (HbA1c) is sometimes measured to determine the need of an oral glucose tolerance test (OGTT). However, HbA1c does not accurately reflect glycemic status in certain conditions. This study was performed to test the possibility that measurement...

  • Step counter use in type 2 diabetes: a meta-analysis of randomized controlled trials. Shanhu Qiu; Xue Cai; Xiang Chen; Bingquan Yang; Zilin Sun // BMC Medicine;2014, Vol. 12 Issue 1, p19 

    Background While step counter use has become popular among type 2 diabetes (T2D) patients, its effectiveness in increasing physical activity (PA) and improving glycemic control has been poorly defined. The aim of this meta-analysis of randomized controlled trials (RCTs) was to evaluate the...

  • Does Periodontal Treatment Improve Glycemic Control in Diabetic Patients? A Meta-analysis of Intervention Studies. Janket, S.-J.; Wightman, A.; Baird, A. E.; Van Dyke, T. E.; Jones, J. A. // Journal of Dental Research;Dec2005, Vol. 84 Issue 12, p1154 

    Previous analyses regarding effects of periodontal treatment on glycemic control included studies where causal association might not be assumed, or the results were reported non-quantitatively. We initiated this meta-analysis of 10 intervention studies to quantify the effects of periodontal...

  • Effects of a low-carbohydrate diet on glycemic control in outpatients with severe type 2 diabetes. Haimoto, Hajime; Sasakabe, Tae; Wakai, Kenji; Umegaki, Hiroyuki // Nutrition & Metabolism;2009, Vol. 6, p1 

    We previously demonstrated that a loosely restricted 45%-carbohydrate diet led to greater reduction in hemoglobin A1c (HbA1c) compared to high-carbohydrate diets in outpatients with mild type 2 diabetes (mean HbA1c level: 7.4%) over 2 years. To determine whether good glycemic control can be...

  • A Comparison of Twice-Daily Biphasic Insulin Aspart 70/30 and Once-Daily Insulin Glargine in Persons with Type 2 Diabetes Mellitus Inadequately Controlled on Basal Insulin and Oral Therapy: A Randomized, Open-Label Study. Robert Ligthelm; Titus Gylvin; Tony DeLuzio; Philip Raskin // Endocrine Practice;Jan2011, Vol. 17 Issue 1, p41 

    Objective: To compare efficacy and safety of biphasic insulin aspart 70/30 (BIAsp 30) with insulin (glargine) in type 2 diabetic patients who were not maintaining glycemic control on basal insulin and oral antidiabetic drugs.Methods: In a 24-week, open-label, parallel-group trial, type 2...

  • Sitagliptin: A Review of its Use in the Management of Type 2 Diabetes Mellitus. Dhillon, Sohita // Drugs;2010, Vol. 70 Issue 4, p489 

    Sitagliptin (Januvia™, Glactiv®, Tesavel®) is a dipeptidyl peptidase-4 inhibitor indicated for the treatment of type 2 diabetes mellitus. Oral sitagliptin as monotherapy or combination therapy was generally well tolerated and improved glycaemic control in well designed clinical...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics