Safety, effectiveness, and cost effectiveness of long acting versus intermediate acting insulin for patients with type 1 diabetes: Systematic review and network meta-analysis

Andrea C. Tricco, Huda M. Ashoor, Jesmin Antony, Joseph Beyene, Areti Angeliki Veroniki, Wanrudee Isaranuwatchai, Alana Harrington, Charlotte Wilson, Sophia Tsouros, Charlene Soobiah, Catherine H. Yu, Brian Hutton, Jeffrey S Hoch, Brenda R. Hemmelgarn, David Moher, Sumit R. Majumdar, Sharon E. Straus

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Objective To examine the safety, effectiveness, and cost effectiveness of long acting insulin for type 1 diabetes.

Design Systematic review and network meta-analysis.

Data sources Medline, Cochrane Central Register of Controlled Trials, Embase, and grey literature were searched through January 2013.

Study selection Randomized controlled trials or non-randomized studies of long acting (glargine, detemir) and intermediate acting (neutral protamine Hagedorn (NPH), lente) insulin for adults with type 1 diabetes were included.

Results 39 studies (27 randomized controlled trials including 7496 patients) were included after screening of 6501 titles/abstracts and 190 full text articles. Glargine once daily, detemir once daily, and detemir once/twice daily significantly reduced hemoglobin A1ccompared with NPH once daily in network meta-analysis (26 randomized controlled trials, mean difference-0.39%, 95% confidence interval-0.59% to-0.19%;-0.26%,-0.48% to-0.03%; and-0.36%,-0.65% to-0.08%; respectively). Differences in network meta-analysis were observed between long acting and intermediate acting insulin for severe hypoglycemia (16 randomized controlled trials; detemir once/twice daily versus NPH once/twice daily: odds ratio 0.62, 95% confidence interval 0.42 to 0.91) and weight gain (13 randomized controlled trials; detemir once daily versus NPH once/twice daily: mean difference 4.04 kg, 3.06 to 5.02 kg; detemir once/twice daily versus NPH once daily:-5.51 kg,-6.56 to-4.46 kg; glargine once daily versus NPH once daily:-5.14 kg,-6.07 to-4.21). Compared with NPH, detemir was less costly and more effective in 3/14 cost effectiveness analyses and glargine was less costly and more effective in 2/8 cost effectiveness analyses. The remaining cost effectiveness analyses found that detemir and glargine were more costly but more effective than NPH. Glargine was not cost effective compared with detemir in 2/2 cost effectiveness analyses.

Conclusions Long acting insulin analogs are probably superior to intermediate acting insulin analogs, although the difference is small for hemoglobin A1c. Patients and their physicians should tailor their choice of insulin according to preference, cost, and accessibility.

Systematic review registration PROSPERO CRD42013003610.

Original languageEnglish (US)
Article numberg5459
JournalBMJ (Online)
Volume349
DOIs
StatePublished - Oct 1 2014
Externally publishedYes

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Protamines
Type 1 Diabetes Mellitus
Cost-Benefit Analysis
Insulin
Safety
Randomized Controlled Trials
Long-Acting Insulin
Lente Insulin
Hemoglobins
Isophane Insulin
Confidence Intervals
Literature
Costs and Cost Analysis
Information Storage and Retrieval
Network Meta-Analysis
Hypoglycemia
Weight Gain
Insulin Glargine
Odds Ratio
Physicians

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Safety, effectiveness, and cost effectiveness of long acting versus intermediate acting insulin for patients with type 1 diabetes : Systematic review and network meta-analysis. / Tricco, Andrea C.; Ashoor, Huda M.; Antony, Jesmin; Beyene, Joseph; Veroniki, Areti Angeliki; Isaranuwatchai, Wanrudee; Harrington, Alana; Wilson, Charlotte; Tsouros, Sophia; Soobiah, Charlene; Yu, Catherine H.; Hutton, Brian; Hoch, Jeffrey S; Hemmelgarn, Brenda R.; Moher, David; Majumdar, Sumit R.; Straus, Sharon E.

In: BMJ (Online), Vol. 349, g5459, 01.10.2014.

Research output: Contribution to journalArticle

Tricco, AC, Ashoor, HM, Antony, J, Beyene, J, Veroniki, AA, Isaranuwatchai, W, Harrington, A, Wilson, C, Tsouros, S, Soobiah, C, Yu, CH, Hutton, B, Hoch, JS, Hemmelgarn, BR, Moher, D, Majumdar, SR & Straus, SE 2014, '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 (Online), vol. 349, g5459. https://doi.org/10.1136/bmj.g5459
Tricco, Andrea C. ; Ashoor, Huda M. ; Antony, Jesmin ; Beyene, Joseph ; Veroniki, Areti Angeliki ; Isaranuwatchai, Wanrudee ; Harrington, Alana ; Wilson, Charlotte ; Tsouros, Sophia ; Soobiah, Charlene ; Yu, Catherine H. ; Hutton, Brian ; Hoch, Jeffrey S ; Hemmelgarn, Brenda R. ; Moher, David ; Majumdar, Sumit R. ; Straus, Sharon E. / Safety, effectiveness, and cost effectiveness of long acting versus intermediate acting insulin for patients with type 1 diabetes : Systematic review and network meta-analysis. In: BMJ (Online). 2014 ; Vol. 349.
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abstract = "Objective To examine the safety, effectiveness, and cost effectiveness of long acting insulin for type 1 diabetes.Design Systematic review and network meta-analysis.Data sources Medline, Cochrane Central Register of Controlled Trials, Embase, and grey literature were searched through January 2013.Study selection Randomized controlled trials or non-randomized studies of long acting (glargine, detemir) and intermediate acting (neutral protamine Hagedorn (NPH), lente) insulin for adults with type 1 diabetes were included.Results 39 studies (27 randomized controlled trials including 7496 patients) were included after screening of 6501 titles/abstracts and 190 full text articles. Glargine once daily, detemir once daily, and detemir once/twice daily significantly reduced hemoglobin A1ccompared with NPH once daily in network meta-analysis (26 randomized controlled trials, mean difference-0.39{\%}, 95{\%} confidence interval-0.59{\%} to-0.19{\%};-0.26{\%},-0.48{\%} to-0.03{\%}; and-0.36{\%},-0.65{\%} to-0.08{\%}; respectively). Differences in network meta-analysis were observed between long acting and intermediate acting insulin for severe hypoglycemia (16 randomized controlled trials; detemir once/twice daily versus NPH once/twice daily: odds ratio 0.62, 95{\%} confidence interval 0.42 to 0.91) and weight gain (13 randomized controlled trials; detemir once daily versus NPH once/twice daily: mean difference 4.04 kg, 3.06 to 5.02 kg; detemir once/twice daily versus NPH once daily:-5.51 kg,-6.56 to-4.46 kg; glargine once daily versus NPH once daily:-5.14 kg,-6.07 to-4.21). Compared with NPH, detemir was less costly and more effective in 3/14 cost effectiveness analyses and glargine was less costly and more effective in 2/8 cost effectiveness analyses. The remaining cost effectiveness analyses found that detemir and glargine were more costly but more effective than NPH. Glargine was not cost effective compared with detemir in 2/2 cost effectiveness analyses.Conclusions Long acting insulin analogs are probably superior to intermediate acting insulin analogs, although the difference is small for hemoglobin A1c. Patients and their physicians should tailor their choice of insulin according to preference, cost, and accessibility.Systematic review registration PROSPERO CRD42013003610.",
author = "Tricco, {Andrea C.} and Ashoor, {Huda M.} and Jesmin Antony and Joseph Beyene and Veroniki, {Areti Angeliki} and Wanrudee Isaranuwatchai and Alana Harrington and Charlotte Wilson and Sophia Tsouros and Charlene Soobiah and Yu, {Catherine H.} and Brian Hutton and Hoch, {Jeffrey S} and Hemmelgarn, {Brenda R.} and David Moher and Majumdar, {Sumit R.} and Straus, {Sharon E.}",
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T1 - Safety, effectiveness, and cost effectiveness of long acting versus intermediate acting insulin for patients with type 1 diabetes

T2 - Systematic review and network meta-analysis

AU - Tricco, Andrea C.

AU - Ashoor, Huda M.

AU - Antony, Jesmin

AU - Beyene, Joseph

AU - Veroniki, Areti Angeliki

AU - Isaranuwatchai, Wanrudee

AU - Harrington, Alana

AU - Wilson, Charlotte

AU - Tsouros, Sophia

AU - Soobiah, Charlene

AU - Yu, Catherine H.

AU - Hutton, Brian

AU - Hoch, Jeffrey S

AU - Hemmelgarn, Brenda R.

AU - Moher, David

AU - Majumdar, Sumit R.

AU - Straus, Sharon E.

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Objective To examine the safety, effectiveness, and cost effectiveness of long acting insulin for type 1 diabetes.Design Systematic review and network meta-analysis.Data sources Medline, Cochrane Central Register of Controlled Trials, Embase, and grey literature were searched through January 2013.Study selection Randomized controlled trials or non-randomized studies of long acting (glargine, detemir) and intermediate acting (neutral protamine Hagedorn (NPH), lente) insulin for adults with type 1 diabetes were included.Results 39 studies (27 randomized controlled trials including 7496 patients) were included after screening of 6501 titles/abstracts and 190 full text articles. Glargine once daily, detemir once daily, and detemir once/twice daily significantly reduced hemoglobin A1ccompared with NPH once daily in network meta-analysis (26 randomized controlled trials, mean difference-0.39%, 95% confidence interval-0.59% to-0.19%;-0.26%,-0.48% to-0.03%; and-0.36%,-0.65% to-0.08%; respectively). Differences in network meta-analysis were observed between long acting and intermediate acting insulin for severe hypoglycemia (16 randomized controlled trials; detemir once/twice daily versus NPH once/twice daily: odds ratio 0.62, 95% confidence interval 0.42 to 0.91) and weight gain (13 randomized controlled trials; detemir once daily versus NPH once/twice daily: mean difference 4.04 kg, 3.06 to 5.02 kg; detemir once/twice daily versus NPH once daily:-5.51 kg,-6.56 to-4.46 kg; glargine once daily versus NPH once daily:-5.14 kg,-6.07 to-4.21). Compared with NPH, detemir was less costly and more effective in 3/14 cost effectiveness analyses and glargine was less costly and more effective in 2/8 cost effectiveness analyses. The remaining cost effectiveness analyses found that detemir and glargine were more costly but more effective than NPH. Glargine was not cost effective compared with detemir in 2/2 cost effectiveness analyses.Conclusions Long acting insulin analogs are probably superior to intermediate acting insulin analogs, although the difference is small for hemoglobin A1c. Patients and their physicians should tailor their choice of insulin according to preference, cost, and accessibility.Systematic review registration PROSPERO CRD42013003610.

AB - Objective To examine the safety, effectiveness, and cost effectiveness of long acting insulin for type 1 diabetes.Design Systematic review and network meta-analysis.Data sources Medline, Cochrane Central Register of Controlled Trials, Embase, and grey literature were searched through January 2013.Study selection Randomized controlled trials or non-randomized studies of long acting (glargine, detemir) and intermediate acting (neutral protamine Hagedorn (NPH), lente) insulin for adults with type 1 diabetes were included.Results 39 studies (27 randomized controlled trials including 7496 patients) were included after screening of 6501 titles/abstracts and 190 full text articles. Glargine once daily, detemir once daily, and detemir once/twice daily significantly reduced hemoglobin A1ccompared with NPH once daily in network meta-analysis (26 randomized controlled trials, mean difference-0.39%, 95% confidence interval-0.59% to-0.19%;-0.26%,-0.48% to-0.03%; and-0.36%,-0.65% to-0.08%; respectively). Differences in network meta-analysis were observed between long acting and intermediate acting insulin for severe hypoglycemia (16 randomized controlled trials; detemir once/twice daily versus NPH once/twice daily: odds ratio 0.62, 95% confidence interval 0.42 to 0.91) and weight gain (13 randomized controlled trials; detemir once daily versus NPH once/twice daily: mean difference 4.04 kg, 3.06 to 5.02 kg; detemir once/twice daily versus NPH once daily:-5.51 kg,-6.56 to-4.46 kg; glargine once daily versus NPH once daily:-5.14 kg,-6.07 to-4.21). Compared with NPH, detemir was less costly and more effective in 3/14 cost effectiveness analyses and glargine was less costly and more effective in 2/8 cost effectiveness analyses. The remaining cost effectiveness analyses found that detemir and glargine were more costly but more effective than NPH. Glargine was not cost effective compared with detemir in 2/2 cost effectiveness analyses.Conclusions Long acting insulin analogs are probably superior to intermediate acting insulin analogs, although the difference is small for hemoglobin A1c. Patients and their physicians should tailor their choice of insulin according to preference, cost, and accessibility.Systematic review registration PROSPERO CRD42013003610.

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