- Available basal insulin analogs do not appear to differ in glucose-lowering capacity, although some may result in less nocturnal hypoglycemia or weight gain.
- Therapeutic decisions should be based on short-term efficacy and safety, effects on long-term cardiovascular outcomes, and cost-effectiveness.
Why this matters
- Insulin therapy is necessary for many patients with type 2 diabetes (T2D).
- Meta-analysis, 39 randomized controlled trials, ≥12 weeks, comparing insulin analogs in 26,195 patients with T2D.
- Funding: None.
- Degludec (Tresiba) thrice weekly was less effective at reducing HbA1c (mean differences [MDs]):
- from 0.21% vs degludec 100 U/mL (95% CI, 0.03%-0.38%) to
- 0.32% vs glargine (Lantus) 300 U/mL (glargine-300) (0.13%-0.51%).
- Detemir (Levemir) was inferior to:
- glargine 100 U/mL (glargine-100) (MD, 0.15%; 95% CI, 0.04%-0.25%), and
- glargine-300 (0.20%; 0.05%-0.35%).
- Weight profiles were superior with glargine-300 vs comparators, with differences ranging from −0.68 kg vs glargine-300 to −1.76 kg vs LY2963016 (basaglar).
- Nocturnal hypoglycemia lower with degludec 100 U/mL, degludec 200 U/mL, and glargine-300 vs glargine-100, LY2963016, and neutral protamine lispro (NPL) suspension.
- Severe hypoglycemia rates similar except for higher rates with NPL.
- Only studies comparing analogs to each other included.
- All but 4 studies were industry-funded.
- Many comparisons indirect.
- Hypoglycemia definitions differed.