Systematic review and economic evaluation of a long-acting insulin analogue, insulin glargine

Warren, Emma; Weatherley-Jones, Elaine; Chilcott, Jim; Beverley, Catherine

doi:10.3310/hta8450

Cited by 81 publications

(56 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1), a conclusion that is also supported by a systematic review of glargine (25). It is important to note that, in many cases, longacting insulin analogs, with their improved predictability and flatter absorption profile, can lower the frequency of (nonsevere) nocturnal hypoglycemia (24).…”

Section: Hypoglycemiamentioning

confidence: 87%

“…In contrast, in most studies, severe hypoglycemia has not been reduced by switching to either glargine-or detemirbased MDI regimens (21)(22)(23)(24)(25) (Fig. 1), a conclusion that is also supported by a systematic review of glargine (25).…”

Section: Hypoglycemiamentioning

confidence: 91%

“…However, it is also the case that long-acting analog regimens are associated with a lower fasting blood glucose level than isophane MDI, and the dawn phenomenon can be successfully managed by glargine or detemir in many patients (24,25). The dawn phenomenon is now one of the less common reasons for starting patients on CSII in our pump clinic.…”

Section: Dawn Phenomenonmentioning

confidence: 99%

See 2 more Smart Citations

Long-Acting Insulin Analogs Versus Insulin Pump Therapy for the Treatment of Type 1 and Type 2 Diabetes

Pickup

Renard

2008

Diabetes Care

View full text Add to dashboard Cite

Insulin pump therapy (continuous subcutaneous insulin infusion [CSII]) is now an established form of intensive insulin treatment. It is pertinent to ask, however, if multiple daily injection (MDI) regimens based on new long-acting insulin analogs such as glargine and detemir have now replaced the need for CSII. In type 1 diabetes, CSII reduces the frequency of severe hypoglycemia compared with isophane-based MDIs, but the rate of severe hypoglycemia is usually similar on glargine-or detemir-based MDIs compared with isophane-based MDIs. CSII reduces A1C and glycemic variability compared with isophane-based MDIs; but glargine and detemir do not improve A1C or variability in many patients, particularly those who are prone to hypoglycemia. Head-to-head comparisons of CSII with MDI based on glargine indicate lower A1C, fructosamine, or glucose levels on CSII. It can be concluded that long-acting insulin analogs have not yet replaced the need for insulin pump therapy in type 1 diabetes, and CSII is the best current therapeutic option for some type 1 diabetic subjects. In type 2 diabetes, CSII and MDI produce similar glycemic control, although there is little study of MDI based on long-acting analogs compared with pumps. It is possible that CSII will be beneficial in selected patient groups with type 2 diabetes, but this requires further study. Diabetes Care 31 (Suppl. 2):S140-S145, 2008F or many decades, it has been accepted that poor glycemic control in insulin injection-treated diabetes is mainly due to the inadequacies of insulin pharmacology (1,2). Regular (shortacting) insulin is absorbed too slowly from the subcutaneous site to control postprandial hyperglycemia, and the delayed absorption then results in late hypoglycemia. Both of these problems have now been much improved by the introduction of more quickly absorbed monomeric insulins (3). The problems of longacting insulin formulations such as isophane and lente have taken longer to improve: they produce "hill-like" blood concentration and action profiles, resulting in a peak of over-insulinization in the middle of the night with a consequent risk of hypoglycemia, and a waning in insulinization before breakfast, resulting in fasting hyperglycemia (1,2,4). Moreover, these delayed-action insulin suspensions also have huge variability of subcutaneous absorption (1), contributing to much of the unpredictability in within-and between-day blood glucose control.The development of insulin pump therapy (continuous subcutaneous insulin infusion [CSII]) nearly 30 years ago (5) did much to overcome the problems of long-acting insulin injections. The constancy of the basal delivery allows for a near-flat blood insulin profile, adjustable at preset times to suit the changing needs of the patient throughout the day. The controlled delivery of small insulin amounts substantially reduces glycemic variability (6,7). For many years, these advantages have allowed a superiority of insulin pump therapy over insulin injection regimens, at least as far as the frequency of hypoglycem...

show abstract

Section: Hypoglycemiamentioning

confidence: 87%

Section: Hypoglycemiamentioning

confidence: 91%

Section: Dawn Phenomenonmentioning

confidence: 99%

See 1 more Smart Citation

Long-Acting Insulin Analogs Versus Insulin Pump Therapy for the Treatment of Type 1 and Type 2 Diabetes

Pickup

Renard

2008

Diabetes Care

View full text Add to dashboard Cite

show abstract

“…(16) Three CUAs found that iGlarg was cost effective compared to iNPH, (45)(46)(47) another found that iGlarg was dominant compared to iNPH,(48) while another found that iGlarg was not cost effective compared to iNPH. (16) One CUA found that iDet was dominant (less costly and more effective) over iGlarg, (44) while another found that iGlarg was the dominant option when compared to iDet.…”

Section: Discussionmentioning

confidence: 99%

Basal Insulin Regimens for Adults with Type 1 Diabetes Mellitus: A Cost-Utility Analysis

et al. 2017

View full text Add to dashboard Cite

ObjectivesTo assess the cost effectiveness of basal insulin regimens for adults with Type 1 diabetes (T1D) in England. MethodsCost-utility analysis (CUA) was undertaken in accordance with NICE reference case. UK NHS and personal and social services (PSS) perspective was used and 3.5% discount rate applied for both costs and outcomes. Relative effectiveness estimates were based on a systematic review of published trials and a Bayesian network meta-analysis (NMA). The IMS CORE Diabetes Model (CDM) was used, where net monetary benefit (NMB) was calculated using a threshold of £20,000 per quality-adjusted life-year (QALY) gained. Wide range of sensitivity analyses was undertaken. ResultsInsulin detemir (twice-daily) [iDet (bid)] had the highest mean QALY gain (11.09 QALYs) and NMB (£181,456) per patient over the model time horizon. Compared to the lowest cost strategy (insulin NPH once daily [iNPH (od)]; it had an incremental cost-effectiveness ratio (ICER) of £7,844 per QALY-gained. Insulin glargine (od) [iGlarg (od)] and iDet (od) were ranked as second and third, with NMB of £180,893 and £180,423, respectively. iDet (bid)] remained the most cost-effective treatment throughout the sensitivity analyses performed except when high doses were assumed (>30% increment compared to other regimens); where in this scenario analysis iGlarg (od) ranked first. ConclusionsiDet (bid) is the most cost-effective regimen; providing the highest QALY gain and NMB. iGlarg (od) and iDet (od) are possible options for those for whom the twice daily regimen of insulin determir is not acceptable or does not achieve required glycaemic control.

show abstract

“…Esta indicação é reforçada pela heterogeneidade dos resultados na redução da hipoglicemia grave com a utilização do esquema de múlti-plas doses de insulina (MDI), com os análogos de insulina de ação curta e lenta (10)(11)(12)(13)(14)(15). Esses estudos têm mostrado que a utilização desses análogos reduzem as hipoglicemias leves, moderadas e noturnas, mas não as graves.…”

unclassified

Comparação entre a bomba de infusão de insulina subcutânea e o esquema de múltiplas doses de insulina em adolescentes com diabetes melito do tipo 1 da rede pública de saúde na abordagem da hipoglicemia grave

Gabbay

Dib

2007

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

RESUMOObjetivo: Avaliação comparativa da freqüência de hipoglicemia severa após mudança da terapia com múltiplas doses de insulina (MDI) para bomba de insulina subcutânea (BIISC). Pacientes e Métodos: Sete pacientes DM1, idade Mi = 14 anos e tempo médio de diabetes de 8 anos, comparados de acordo com a incidência de hipoglicemia, a dose total de insulina (U/Kg/d), IMC (Kg/m 2 ) e HbA1c (vn: 3,5-6,7%) 1 ano antes e 1 ano após a transferência de terapêutica. Houve redução significativa dos episódios de hipoglicemia severa (1,3 episódio/paciente/ano para zero episódio/paciente/ano; p = 0,04), na dose total diária de insulina (1,33 ± 0,26 U/Kg/dia para 0,87 ± 0,17 U/kg/dia; p = 0,04) e na HbA1c (8,7 ± 0,7% para 7,8 ± 0,9%; p = 0,05 com BIISC). Concluímos que a BIISC é eficaz e segura na redução de hipoglicemia severa em um subgrupo de pacientes DM1 com MDI. Entretanto, os resultados obtidos precisam ser reproduzidos em centros semelhantes e estudos de custo são necessários para que a sua viabilidade seja confirmada e aplicada nos sistemas públicos de saúde, que correspondem à maioria no nosso país. ABSTRACT Comparison Between Continuous Subcutaneous Insulin Infusion and Multiple Daily Injection Regimens in Adolescent with Type 1Diabetes from a Public Health Care System Approach to Severe Hypoglycemia. Objective: We compared the incidence of severe hypoglycemia episodes with therapy with multiple doses of insulin (MDI) and after changing to pump (CSII). Patients and methods: 7 T1DM patients with 14 years median and median duration of diabetes of 8 years. We analyzed insulin requirement (U/kg/day), BMI (Kg/m 2 ), HbA1c (normal range: 3.5-6.7%) one year before and one year after changing therapy. The severe hypoglycemia episodes decreased from 1.3 to 0 episodes/patient/year; p = 0.00). The insulin requirement decreased from 1.33 ± 0.26 U/Kg/day to 0.87 ± 0.17 U/kg/day; p = 0.04 and HbA1c decreased from 8.7 ± 0.7% to 7.8 ± 0.9%; p = 0.05. Conclusion: CSII is efficient in decreasing severe hypoglycemia in a subgroup of T1DM using MDI also in Public Health Care System (PHCS) conditions. However, these finding should be reproduced by other Diabetes Care centers and cost studies are necessary to confirm the viability and possibility of this therapy, when necessary, to T1DM patients, which correspond to the majority of these individuals in our country, seeing in the PHCS.

show abstract

Systematic review and economic evaluation of a long-acting insulin analogue, insulin glargine

Cited by 81 publications

References 14 publications

Long-Acting Insulin Analogs Versus Insulin Pump Therapy for the Treatment of Type 1 and Type 2 Diabetes

Long-Acting Insulin Analogs Versus Insulin Pump Therapy for the Treatment of Type 1 and Type 2 Diabetes

Basal Insulin Regimens for Adults with Type 1 Diabetes Mellitus: A Cost-Utility Analysis

Comparação entre a bomba de infusão de insulina subcutânea e o esquema de múltiplas doses de insulina em adolescentes com diabetes melito do tipo 1 da rede pública de saúde na abordagem da hipoglicemia grave

Contact Info

Product

Resources

About