A Cochrane review included 9 studies comparing short acting insulin analogues (Lispro, Aspart, Glulisine) to regular human insulin, with a total of 2 693 subjects. In patients with type 1 diabetes, the weighted mean difference (WMD) of HbA1c was –0.15% in favour of insulin analogue . The incidence of severe hypoglycaemia was slightly lower with insulin analogues compared with regular insulin . No study was designed to investigate possible long term effects (e.g. mortality, diabetic complications), in particular in patients with diabetes related complications.
| Outcome | Relative effect (95% CI) N | Control - Regular human insulin | Intervention - Short-acting insulin analogues (95% CI) | No of participants (studies) Quality of evidence |
|---|---|---|---|---|
| Severe hypoglycaemic episodes (heterogeneous definitions) Follow-up: 24-52 weeks | OR 0.89 (0.71 to 1.12) | 166 per 1000 | 150 per 1000 (124 to 182) | 2459 (7) Very low |
| HbA1c at end of follow-up [%] Follow-up: 24-52 weeks - | - | The mean HbA1c ranged from 6.3% to 9.3% | The mean HbA1c was 0.15% lower (0.2 lower to 0.1 lower) | 2608 (9) Low |
Comment: The quality of evidence is downgraded by limitations in study quality and by inconsistency (heterogeneity in interventions and outcomes).