Efficacy and safety among second-generation and other basal insulins in adult patients with type 1 diabetes: a systematic review and network meta-analysis
- 28 July 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Naunyn-Schmiedebergs Archiv für experimentelle Pathologie und Pharmakologie
- Vol. 394 (10), 2091-2101
- https://doi.org/10.1007/s00210-021-02128-9
Abstract
We aimed to assess the comparative efficacy and safety of second-generation basal insulins (glargine U300 and degludec U100) vs. neutral protamine Hagedorn (NPH) and first-generation basal insulins (glargine U100 and detemir) in type 1 diabetes (T1D) adults. PubMed, the Cochrane Library, ClinicalTrials.gov, and Google Scholar (until January 2021) were systematically searched. Randomized controlled trials (RCTs) with ≥ 12 weeks of follow-up comparing efficacy (HbA1c) or safety (hypoglycemia and weight gain) between second-generation basal insulins vs. other basal insulins in T1D adults were included. Bayesian network meta-analyses were used to estimate risk ratio, hazard ratio, and mean difference. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to appraise evidence certainty. Eighteen RCTs (≥ 24 weeks of follow-up) involving 7283 randomized participants were included for main analysis. Moderate to high certainty evidence suggested that second-generation basal insulins showed equivalent HbA1c reduction compared with NPH and first-generation basal insulins. Compared with second-generation basal insulins, low to high certainty evidence suggested that NPH was associated with a higher risk of patients experiencing severe hypoglycemia; NPH and first-generation basal insulins were associated with a higher rate of nocturnal confirmed hypoglycemic events. For the weight gain, glargine U300 was comparable to detemir (low certainty), but degludec U100 was greater than detemir (moderate certainty). In conclusion, second-generation basal insulins maintained equivalent efficacy of glycemic control (moderate to high certainty), with differences in safety (low to high certainty) compared with NPH and first-generation basal insulins during ≥ 24 weeks of follow-up in T1D adults.Keywords
This publication has 36 references indexed in Scilit:
- Evidence Synthesis for Decision Making 4Medical Decision Making, 2013
- Evidence Synthesis for Decision Making 2Medical Decision Making, 2012
- Insulin degludec: four times lower pharmacodynamic variability than insulin glargine under steady‐state conditions in type 1 diabetesDiabetes, Obesity and Metabolism, 2012
- Using network meta‐analysis to evaluate the existence of small‐study effects in a network of interventionsResearch Synthesis Methods, 2012
- Consistency and inconsistency in network meta‐analysis: concepts and models for multi‐arm studiesResearch Synthesis Methods, 2012
- The Barrier of Hypoglycemia in DiabetesDiabetes, 2008
- Potential flaws and biases in a randomized controlled trial (RCT) of insulin determir vs. insulin glargine by Pieber and colleaguesDiabetic Medicine, 2008
- Comparison of insulin detemir and insulin glargine in subjects with Type 1 diabetes using intensive insulin therapyDiabetic Medicine, 2007
- Insulin‐associated weight gain in diabetes – causes, effects and coping strategiesDiabetes, Obesity and Metabolism, 2006