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Long‐acting insulin analogues vs. NPH human insulin in type 1 diabetes. A meta‐analysis

2008; Wiley; Volume: 11; Issue: 4 Linguagem: Inglês

10.1111/j.1463-1326.2008.00976.x

1463-1326

Matteo Monami, Niccolò Marchionni, Edoardo Mannucci,

Pancreatic function and diabetes

Aim: Basal insulin in type 1 diabetes can be provided using either NPH (Neutral Protamine Hagedorn) human insulin or long‐acting insulin analogues, which are supposed to warrant a better metabolic control with reduced hypoglycaemic risk. Aim of this meta‐analysis is the assessment of differences with respect to HbA1c (Glycated hemoglobin), incidence of hypoglycaemia, and weight gain, between NPH human insulin and each long‐acting analogue. Methods: Of 285 randomized controlled trials with a duration > 12 weeks comparing long‐acting insulin analogues (detemir or glargine) with NPH insulin in type 1 diabetic patients identified through Medline search and searches on www.clinicaltrials.gov , 20 met eligibility criteria (enrolling 3693 and 2485 in the long‐acting analogues and NPH group respectively). Data on HbA1c and body mass index at endpoint, and incidence of any, nocturnal and severe hypoglycaemia, were extracted and meta‐analysed. Results: Long‐acting analogues had a small, but significant effect on HbA1c [‐0.07 (−0.13; −0.01)%; p = 0.026], in comparison with NPH human insulin. When analysing the effect of long‐acting analogues on body weight, detemir was associated with a significantly smaller weight gain than human insulin [by 0.26 (0.06;0.47) kg/m 2 ; p = 0.012]. Long‐acting analogues were associated with a reduced risk for nocturnal and severe hypoglycaemia [OR (Odd Ratio, 95% Confidence Intervals) 0.69 (0.55; 0.86), and OR 0.73 (0.60; 0.89) respectively; all p < 0.01]. Conclusions: The switch from NPH to long‐acting analogues as basal insulin replacement in type 1 diabetic patients had a small effect on HbA1c, and also reduced the risk of nocturnal and severe hypoglycaemia.