Basal insulin analogs have similar glucose-lowering capacities

  • Ann Intern Med

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • 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).

Study design

  • Meta-analysis, 39 randomized controlled trials, ≥12 weeks, comparing insulin analogs in 26,195 patients with T2D.
  • Funding: None.

Key results

  • 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.  

Limitations

  • Only studies comparing analogs to each other included.
  • All but 4 studies were industry-funded.
  • Many comparisons indirect.
  • Hypoglycemia definitions differed.

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