Newer and older insulin formulations offer similar glucose-lowering effect

1. Basal insulin analogues do not differ significantly in providing glucose control.

2. Some insulin formulations may have more favorable effects on patient weight compared to others.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Type 2 diabetes (T2DM) has significant morbidity if untreated and affects a large proportion of North Americans annually. As a result, significant efforts have been made to develop various insulin regimens and analogues. The authors of this study aimed to compare efficacy and safety of basal insulin analogues in patients with T2DM. The results of the systematic review and meta-analysis suggested that both newer and older insulin formulations provide similar glucose control among patients. This study had several limitations. First, based on inclusion criteria, the study could not compare basal insulin regimens with other premixed regimens or NPH. Further, the authors determined that confidence in summary estimates was low or very low. This classification was based on the individual studies inconsistency, imprecision, and other limitations.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Use of a basal-plus insulin regimen in persons with type 2 diabetes stratified by age and body mass index: A pooled analysis of four clinical trials

In-Depth [systematic review]: The authors conducted a systematic review and meta-analysis, in order to compare glucose-lowering effects of basal insulin levels for adults with T2DM. A total of 38 studies were included in the final, quantitative analysis. Inclusion criteria for the study consisted of randomized controlled trials of at least 12 weeks duration comparing basal insulin analogues in adults with T2DM. Generally, the authors concluded that evidence was low to very-low-quality, based on their data appraisal. Keeping in mind this limitation, there were few differences in terms of hypoglycemia rates among all analogues compared. High to moderate-quality evidence indicated that detemir had a favorable weight profile compared to other basal insulin analogues.

Image: PD

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