Comparative effectiveness and harms of long‐acting insulins for type 1 and type 2 diabetes: A systematic review and meta‐analysis

Abstract

Aim: To review evidence comparing benefits and harms of long-acting insulins in patients with type 1 and 2 diabetes.Methods: MEDLINE and two Cochrane databases were searched during February 2018. Two authors selected studies meeting inclusion criteria and assessed their quality. Comparative studies of adult or paediatric patients with diabetes treated with insulin degludec, detemir or glargine were included. Meta-analysis was used to combine results of similar studies, and the I 2 statistic calculated to assess statistical heterogeneity.Results: Of 2534 citations reviewed, 70 studies met the inclusion criteria. No statistically significant differences in HbA1c were seen between any two insulins or formulations. Hypoglycaemia was less probable with degludec than with glargine, including nocturnal hypoglycaemia in type 1 (rate ratio 0.68, 95% CI 0.56-0.81) and type 2 diabetes (rate ratio 0.73, 95% CI 0.65-0.82), and severe hypoglycaemia in type 2 diabetes (relative risk 0.72, 95% CI 0.54-0.96). Patients with type 2 diabetes had higher rates of withdrawal because of adverse events when treated with detemir compared with glargine (relative risk 2.1, 95% CI 1.4-3.3). Adults taking detemir gained about 1 kg less body weight than those taking degludec (type 1) or glargine (type 2).Conclusions: No differences in glycaemic control were seen between insulin degludec, detemir and glargine. Hypoglycaemia was less probable with degludec than glargine, and patients taking detemir gained less body weight than those given degludec or glargine. In type 2 diabetes, withdrawals as a result of adverse events were more probable with detemir than glargine. K E Y W O R D Sbasal insulin, glycaemic control, hypoglycaemia, systematic review, type 1 diabetes, type 2 diabetes

Reduced Rates of Hypoglycemia in Type 1 or Type 2 Diabetes After Switching to Insulin Degludec: Results from the Italian Cohort of the ReFLeCT Study

“…CI Confidence interval, PYE patient-year, RR rate ratio, T1D/T2D type 1/type 2 diabetes mellitus with a minimal increase in body weight. The very modest, though significant, increase in body weight in patients with T1D is not consistent with trial results [33]. Speculative explanations include: (1) the prior use of detemir, which is associated with less weight gain, in a subset of patients; (2) the correction of a relative hypo-insulinization with the prior basal regimen; (3) differences in the induction of satiety.…”

Efficacy and safety of GLP-1 receptor agonists as add-on to SGLT2 inhibitors in type 2 diabetes mellitus: A meta-analysis

“…degludec vs glargine), as already stated. Current evidence does not support any difference in change in body weight between these two insulins, therefore the overall results of our meta-analysis evaluating changes in body weight following the addition of GLP-1RA to SGLT2i should not be affected by the trial design and data of DUAL IX 29 .…”

Obesity in Patients with Type 1 Diabetes: Links, Risks and Management Challenges

“… 56 In a recent meta-analysis including patients with T1D and T2D, those receiving insulin detemir gained less body weight than those given degludec or Glar-100. 57 Another systematic review concluded there was less weight gain with basal insulin analogues detemir and Glar-300 compared to Glar-100 and degludec but with a low quality of evidence. 58 Therefore, in the case of obesity and T1D, switching long-acting insulin to either detemir or Glar-300 could be somewhat useful to prevent weight gain.…”