Evidence Summary
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Key messages from scientific research that's ready to be acted on
Got It, Hide thisIn 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) |
Related Topics
Glossary
Studies where people are assigned to one of the treatments purely by chance.
A comprehensive evaluation of the available research evidence on a particular topic.
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