Systematic Review and Meta-analysis of Short-Acting Insulin Analogues in Patients With Diabetes Mellitus

Plank, Johannes; Siebenhofer, Andrea; Berghold, Andrea; Jeitler, Klaus; Horvath, Karl; Mrak, Peter; Pieber, Thomas R.

doi:10.1001/archinte.165.12.1337

Cited by 130 publications

(95 citation statements)

References 68 publications

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“…Rank 1 represents the insulin analog most likely to be the first choice for treatment of type 1 diabetes mellitus. HbA1C values, are in agreement with those that have been found by other authors (Jansson et al, 1998;Siebenhofer et al, 2004;Plank et al, 2005;Forst, Pfützner, 2007).The results of the long-and short-acting insulin analogues are consistent, and direct and indirect comparisons did not reveal significant differences among human insulin and insulin analogues with regard to their ability to reduce HbA1C values. Therefore, although there is a ranking system that can be used to choose the best option for insulin therapy, the differences in efficacy between them are small.…”

supporting

confidence: 91%

“…There are many good insulin formulations; however, metabolic control in many patients remains unsatisfactory (Plank et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

“…The Diabetes Control and Complications Trial (DCCT) and the UK Prospective Diabetes Study confirmed the benefits of improved glycemic control (DCCT, 1993; UKPDS, 1998). To implement intensive insulin therapy, a physiologic model of insulin replacement is applied to most patients with type 1 diabetes mellitus (Pieber et al, 1995).There are many good insulin formulations; however, metabolic control in many patients remains unsatisfactory (Plank et al, 2005).For many years, the most commonly used type of insulin that provided a basal insulin supply was NPH (Neutral Protamine de Hagedorn); however, it has been shown to frequently result in nocturnal hypoglycemia due to unintended plasma insulin peaks (Rosenstock et al, 2005). Injection of regular human insulin does not replicate the postprandial endogenous secretion of insulin.…”

mentioning

confidence: 99%

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Insulin analogues versus human insulin in type 1 diabetes: direct and indirect meta-analyses of efficacy and safety

Sanches

Correr

Venson

et al. 2013

Braz. J. Pharm. Sci.

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All patients with Diabetes Mellitus (DM) receive insulin therapy. In this study, we evaluated the efficacy, safety and tolerability of human insulin and insulin analogues. We performed a systematic review of the literature and a meta-analysis according to the Cochrane Collaboration methodology. In the absence of clinical studies comparing insulins, we performed a mixed treatment comparison to establish the differences between the active treatments. We included studies published from 1995 to 2010. HbA1c results, episodes of hypoglycemia and nocturnal hypoglycemia data were extracted and analyzed. Thirty-five randomized clinical trials were selected after examining the abstract and a full text review. These studies included 4,206 patients who received long-acting insulin analogues and 5,733 patients who received short-acting insulin analogues. Pooled data regarding efficacy indicated no significant differences in HbA1c values between glargine or detemir (once daily) and NPH insulin. However, a twice-daily dose of detemir produced differences in HbA1c values that favored detemir (-0.14% [95% CI: -0.21 to -0.08]; p<0.0001; I 2 =0%). Direct and indirect comparisons are consistent and show that there were no significant differences between human insulin and insulin analogues in efficacy or safety.Our results indicate that long-and short-acting insulin analogues offer few clinical advantages over conventional human insulin. Uniterms:Insulins/meta-analysis. Diabetes mellitus/type 1. Insulin/treatment efficacy. Insulin/safety use.Todos os pacientes com Diabetes Mellitus (DM) tipo 1 recebem insulina. Neste estudo, avaliaram-se eficácia, segurança e tolerabilidade de insulinas humanas e análogas. Realizou-se uma revisão sistemática e meta-análise, de acordo com o preconizado pela Colaboração Cochrane. Na ausência de estudos clínicos comparando insulinas entre si, realizaram-se meta-análises de comparações indiretas a fim de estabelecer diferenças entre tratamentos ativos. Incluíram-se estudos de 1995 a 2010. Resultados de HbA1c, episódios de hipoglicemia e hipoglicemia noturna foram extraídos e analisados. Após leitura de resumos e, posteriormente, de artigos na íntegra, selecionaram-se 35 ensaios clínicos randomizados, totalizando 4206 pacientes utilizando insulina análoga de longa duração e 5733 pacientes insulina análoga de curta duração. Os resultados não demonstraram diferença estatisticamente significativa para redução de HbA1c entre glargina e detemir (uma vez ao dia) comparados a NPH. No entanto, insulina detemir utilizada duas vezes ao dia reduz a HbA1c (-0.14% [95% CI: -0.21 to -0.08]; p<0.0001; I 2 =0%). Comparações diretas e indiretas indicam que não existem diferenças significativas na médica de redução de HbA1c, independente da posologia de detemir, sendo estes resultados de eficácia e segurança consistentes. Os resultados indicam que insulinas análogas de longa ou curta duração apresentam pequenas vantagens, quando comparadas às insulinas tradicionais. Ademais, não existem diferenças entre eficácia e seguran...

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supporting

confidence: 91%

“…There are many good insulin formulations; however, metabolic control in many patients remains unsatisfactory (Plank et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Insulin analogues versus human insulin in type 1 diabetes: direct and indirect meta-analyses of efficacy and safety

Sanches

Correr

Venson

et al. 2013

Braz. J. Pharm. Sci.

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“…15,16 Research has also focused on the drug delivery method. For example, Phillip et al 17 showed that the initial insulin dose (IU/kg) in MDI therapy, in patients with type 1 diabetes mellitus, was significantly reduced after switching to CSII therapy.…”

Section: Discussionmentioning

confidence: 99%

Comparison of continuous subcutaneous insulin infusion and multiple daily insulin injections in Chinese patients with type 2 diabetes mellitus

et al. 2014

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Objective: To investigate prospectively the insulin dose requirements of Chinese patients with type 2 diabetes mellitus treated with either multiple daily insulin injections (MDI) or continuous subcutaneous insulin infusion (CSII) therapy during a 2-week therapeutic intervention. Methods: Patients with type 2 diabetes mellitus were randomly assigned to MDI or CSII therapy. The effects of the two treatment methods were determined based on blood glucose parameters, total daily insulin dose and rates of hypoglycaemia. Results: A total of 609 patients were enrolled in the study. Glycaemic goals were achieved after a mean AE SD of 6.90 AE 2.10 and 5.44 AE 2.22 days' treatment in the MDI and CSII groups, respectively. Once stabilized, the mean AE SD total daily insulin doses were 37.12 AE 10.19 IU and 32.58 AE 8.78 IU for the MDI and CSII groups, respectively. Once stabilized, the mean AE SD total basal and bolus doses were 19.46 AE 7.95 IU/day and 17.66 AE 3.53 IU/day for the MDI group, and 22.79 AE 7.55 IU/ day and 9.81 AE 2.64 IU/day for the CSII group, respectively. There were significant differences in the total, basal and bolus insulin doses between the two groups. Conclusion: CSII therapy may be considered as an effective method to achieve good glycaemic control in Chinese patients with type 2 diabetes mellitus.

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“…In 2005, Plank et al [28] found no significant differences in fetal or maternal outcome between pregnant patients using insulin lispro and aspart [28]. A prospective observational study by Durwnald et al [29] demonstrated significantly improved A1c over T2 and T3 in those treated with insulin lispro versus regular insulin (5.9±1.0 vs 6.7±1.3, p=0.009).…”

Section: Lispromentioning

confidence: 99%

Systematic Literature Review of Basal Bolus Insulin Analogue Therapy during Pregnancy

Henderson¹

2015

OGIJ

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Systematic Review and Meta-analysis of Short-Acting Insulin Analogues in Patients With Diabetes Mellitus

Abstract: Our analysis suggests only a minor benefit to hemoglobin A(1c) values in adult patients with type 1 diabetes mellitus but no benefit in the remaining population with type 2 or gestational diabetes from SAI analogue treatment.

Cited by 130 publications

References 68 publications

Insulin analogues versus human insulin in type 1 diabetes: direct and indirect meta-analyses of efficacy and safety

Insulin analogues versus human insulin in type 1 diabetes: direct and indirect meta-analyses of efficacy and safety

Comparison of continuous subcutaneous insulin infusion and multiple daily insulin injections in Chinese patients with type 2 diabetes mellitus

Systematic Literature Review of Basal Bolus Insulin Analogue Therapy during Pregnancy

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