Comparative efficacy and safety of long-acting insulin analogs in patients with type 2 diabetes failing on oral therapy: Systemic review and meta-analyses

Abstract

Aims/Introduction: Although long-acting insulin analogs are recommended in type 2 diabetics failing on oral agents, their efficacy is uncertain. Here we compared the efficacy and safety of regimens based on long-acting insulin analogs with other preparations in insulin-naïve type 2 diabetics failing on oral agents.

Materials and methods: Data from 9548 participants in 22 English studies were included. Most of the studies were of short to medium duration and of low quality.

Results: In terms of decreasing hemoglobin A1c, long-acting insulin analogs were not statistically significant to rapid-acting insulin analogs or intermediate neutral protamine Hagedorn (NPH) insulin or glucagon-like peptide-1 (GLP-1) analogs, and the differences between long-acting and biphasic insulin analogs were marginal. Compared with rapid-acting insulin analogs, long-acting insulin analogs were similar in the incidence of total hypoglycemia, and the superiority in less weight gain was inconsistent. Relative to biphasic insulin analogs, long-acting insulin analogs were associated with lower incidence of total hypoglycemia and less weight gain. Compared with NPH insulin, long-acting insulin analogs were associated with lower incidence of total and nocturnal hypoglycemia. Relative to GLP-1 analogs, long-acting insulin analogs were associated with lower incidence of treatment related adverse events but with greater weight gain.

Conclusions: For type 2 diabetics failing on oral agents, initiating long-acting insulin analogues seems to provide glycemic control similar to rapid-acting insulin analogs or NPH insulin or glucagon-like peptide-1 analogs and slightly inferior to biphasic insulin analogs with fewer side-effects. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2011.00187.x, 2011).

Keywords: Long‐acting insulin analogs; Meta‐analysis; Type 2 diabetes.

Figure 1

Study flow diagram (n = number of trial reports). RCT, randomized clinical trials.

Figure 2

(a) Long‐acting insulin analogs vs rapid‐acting insulin analogs. (b) Long‐acting insulin analogs vs biphasic insulin analogs. (c) Long‐acting insulin analogs vs intermediate‐acting human neutral protamine Hagedorn (NPH) insulin. (d) Long‐acting insulin analogs vs glucagon‐like peptide‐1 (GLP‐1) analogs. WMD, weighted mean differences.