Full Article

McMasterLogo_New-2017-300x165
Back
Evidence Summary

What is an Evidence Summary?

Key messages from scientific research that's ready to be acted on

Got It, Hide this
  • Rating: 4 out of 5 stars

In people with type 1 diabetes, detemir or glargine improved blood sugar control (HbA1c) by a small amount and reduced weight gain compared with once-daily NPH

Tricco AC, Ashoor HM, Antony J, et al. Safety, effectiveness, and cost effectiveness of long acting versus intermediate acting insulin for patients with type 1 diabetes: systematic review and network meta-analysis. BMJ. 2014 Oct 1;349:g5459.

Review question

In people who have type 1 diabetes, does long-acting insulin (glargine or detemir) improve outcomes more than intermediate-acting insulin (neutral protamine Hagedorn [NPH])?

Background

People with type 1 diabetes may take 1 or 2 injections of NPH insulin every day to keep their blood sugar levels within an appropriate range, in addition to taking short-acting insulin at mealtimes.

Newer types of insulin, such as glargine (Lantus®) and detemir (Levemir®) act for a longer time than NPH and therefore might be more effective and require less frequent injections.

How the review was done

The researchers did a systematic review of studies published until January 2013.

They found 27 randomized controlled trials, with 7,496 people (average age 28 to 47 years across the studies). In these trials, 21% to 100% of the people were women.

The key features of the studies were:

  • people had type 1 diabetes for an average of 11 to 27 years; and
  • the average glycated hemoglobin (HbA1c) level ranged from 6.9% to 9.5%.

What the researchers found

Compared with once-daily NPH, glargine once daily, detemir once daily, and detemir once/twice daily reduced HbA1c (26 randomized controlled trials, mean difference in HbA1c less than 0.5%; data from trials were combined using a type of analysis that lets you compare treatments even if they were not compared directly in the individual trials). Weight gain was also somewhat less with detemir or glargine.

Once-daily detemir or glargine did not consistently change the risk of severe hypoglycemia compared with once-daily NPH.

None of the studies was large enough or long enough to test whether detemir or glargine would affect the risk of longer-term complications of diabetes.

Conclusion

In people with type 1 diabetes, detemir or glargine reduced HbA1c by a small amount and reduced weight gain compared with once-daily NPH.

Long-acting insulin vs once-daily NPH in type 1 diabetes*

Type of long-acting insulin

Average difference in HbA1c level at an average of 20 weeks of follow-up (and range of effect)

Average difference in weight at an average of 26 weeks of follow-up (and range of effect)

Detemir (once daily)

0.26% lower with detemir (as little as 0.03% and as much as 0.48% lower)

0.6 kg less weight gain with detemir (as little as 0.1 and as much as 1.1 kg less)

Glargine (once daily)

0.39% lower with glargine (as little as 0.19% and as much as 0.59% lower)

5.1 kg less weight gain with glargine (as little as 4.2 and as much as 6.1 kg less)

HbA1c = glycated hemoglobin; kg = kilogram; NPH = neutral protamine Hagedorn.

*Trials were combined using a type of analysis that lets you compare treatments even if they were not compared directly in the individual trials.

 

View Clinician article

Related Topics

Glossary

Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

Related Evidence Summaries

DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Register for free access to all Professional content

Register