Insulin detemir versus insulin glargine for type 2 diabetes mellitus

There may be no clinically relevant difference in the efficacy or safety between insulin detemir and insulin glargine for targeting hyperglycaemia in patients with type 2 diabetes. Insulin detemir appears to be associated with a higher daily dose and less weight gain, and insulin glargine with once-daily dosing and fewer injection site reactions.

The quality of evidence is downgraded by imprecise results (low number of events, wide confidence intervals) and by study quality (lack of blinding).

Summary

A Cochrane review included 4 studies with a total of 2 250 subjects comparing the effects of insulin detemir and insulin glargine in the treatment of patients with type 2 diabetes mellitus.

The mean difference in HbA1c level between insulin glargine and insulin detemir was not statistically significant: 0.08% (95% CI -0.10 to 0.27, p = 0.38). There was substantial statistical heterogeneity between studies (p = 0.01, I² = 73%). Meta-analysis of change in HbA1c level resulted in mean difference of 0.07% (95% CI -0.10 to 0.24, p = 0.43). There was substantial statistical heterogeneity between studies (p = 0.04, I² = 64%).

Insulin glargine was associated with significantly lower fasting glucose (mean difference of 0.34 mmol/L [95% CI 0.01 to 0.67, p = 0.043]), but not significant fasting glucose lowering than insulin detemir (with statistical heterogeneity [p = 0.11, I² = 50%]).

The percentage of patients achieving good glycaemic control (HbA1c < 7%) was similar between the two insulins (RR 0.96; 95% CI 0.81 to 1.14). There was no difference between the two insulins in the rate of overall, nocturnal or severe hypoglycaemia (RR 1.00; 95% CI 0.90 to 1.11, 1.00; 95% CI 0.03 to 1.09 and 0.88; 95% CI 0.59 to 1.30 respectively).

The mean difference in daily basal insulin dose was a significant 0.26 U/kg (p = 0.00049; 95% CI 0.11 to 0.41), in favour of insulin glargine (statistical heterogeneity between studies: p < 0.00001, I² = 94%). Detemir was associated with significantly less weight gain; mean difference -0.91kg (95% CI -1.21 to -0.61) and significantly more injection site reactions (RR 3.31; 95% CI 1.13 to 9.73) than glargine.

Clinical comments

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Ədəbiyyat

1. Swinnen SG, Simon AC, Holleman F et al. Insulin detemir versus insulin glargine for type 2 diabetes mellitus. Cochrane Database Syst Rev 2011;(7):CD006383.