medwireNews: The results of a network meta-analysis suggest that long-acting insulin analogs have broadly equivalent efficacy and safety in patients with type 2 diabetes, although some might be a little better for preventing nocturnal hypoglycemia.
The study authors stress that the comparisons made in a network meta-analysis are indirect and therefore count as low-quality evidence that should be treated with caution. However, there are almost no head-to-head trials of the long-acting insulin analogs; most of the 38 trials in this analysis compared insulin analogs with glargine 100 U/mL, although there was one direct comparison of detemir and neutral protamine lispro insulin.
Apostolos Tsapas (University of Thessaloniki, Greece) and co-workers did find a few differences, as they report in the Annals of Internal Medicine. For example, they found that detemir seemed to give the most favorable change in bodyweight, with patients achieving a weighted mean difference ranging from 0.68 to 1.76 kg lighter with detemir than with insulin regimens.
The other regimens were degludec 100 and 200 U/mL; thrice-weekly degludec; glargine 100 and 300 U/mL; the glargine biosimilars LY2963016, MK-1293, and MYL-1501D; and neutral protamine lispro.
For nocturnal hypoglycemia, degludec (100 or 200 U/mL) and glargine 300 U/mL appeared to have the edge, significantly reducing the risk for this outcome versus the other studied insulin regimens. The risk for any hypoglycemia was similar among the regimens, but neutral protamine lispro was associated with an increased risk for severe hypoglycemia relative to most other insulins, and it was also associated with an increased risk for nocturnal hypoglycemia.
These effects of neutral protamine lispro, “with no comparative beneficial effects on glycemic control or body weight, raises questions about its clinical utility,” say the researchers.
There were few differences in glycated hemoglobin levels, although thrice-weekly degludec appeared less effective than most other insulin regimens, and detemir was slightly less effective than both glargine regimens.
The researchers say these differences in glycemic control “were minimal and probably lacked clinical significance,” although they stress that they made no comparisons with premixed insulin regimens or with neutral protamine Hagedorn insulin. However, a recent study comparing the latter insulin with long-acting analogs in real-world patients showed that it was just as effective and markedly cheaper.
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