Long-acting insulin analogues versus NPH insulin (human isophane insulin) for type 2 diabetes mellitus

Long-acting insulin analogues (glargin or detemir) appear to cause slightly less nocturnal hypoglycaemic events than NPH insulin. The potential long-term adverse effects of glargin and determir are unknown.

A Cochrane review included 8 studies with a total of 1293 subjects. Duration of the included trials ranged from 24 to 52 weeks. Metabolic control, measured by glycosylated haemoglobin A1c (HbA1c) as a surrogate endpoint, and adverse effects did not differ in a clinical relevant way between treatment groups. While no statistically significant difference for severe hypoglycaemia rates was shown in any of the trials, the rate of symptomatic, overall and nocturnal hypoglycaemia was statistically significantly lower in patients treated with either insulin glargine or detemir. No evidence for a beneficial effect of long-acting analogues on patient-oriented outcomes like mortality, morbidity, quality of life or costs could be obtained.

Comment: The quality of evidence is downgraded by study quality; inadequate reporting of randomisation and lack of blinding.

Weak recommendation: Use long-acting insulin analogues in patients with type 2 diabetes who have nocturnal hypoglycaemia with NPH insulin. The strength of recommendation is downgraded by questionable cost-effectiveness.

Ədəbiyyat

1. Horvath K, Jeitler K, Berghold A, Ebrahim SH, Gratzer TW, Plank J, Kaiser T, Pieber TR, Siebenhofer A. Long-acting insulin analogues versus NPH insulin (human isophane insulin) for type 2 diabetes mellitus. Cochrane Database Syst Rev 2007 Apr 18;(2):CD005613.