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Long-acting insulin analogues for type 1 diabetes : an overview of systematic reviews and meta-analysis of randomized controlled trials

Background The comparison between long acting insulin analogues (LAIA) and human insulin (NPH) has been investigated for decades, with many randomized controlled trials (RCTs) and systematic reviews giving mixed results. This overlapping and contradictory evidence has increased uncertainty on co...

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Main Authors: Laranjeira, Fernanda de Oliveira, Andrade, Keitty Regina Cordeiro de, Figueiredo, Ana Claudia Morais Godoy, Silva, Silva, Everton Nunes da, Pereira, Maurício Gomes
Format: Artigo
Language: Inglês
Published: Plos One 2019
Subjects:
Diabetes
Insulina
Online Access: http://repositorio.unb.br/handle/10482/34687
https://doi.org/10.1371/journal.pone.0194801
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spelling ir-10482-346872019-06-04T12:18:12Z Long-acting insulin analogues for type 1 diabetes : an overview of systematic reviews and meta-analysis of randomized controlled trials Laranjeira, Fernanda de Oliveira Andrade, Keitty Regina Cordeiro de Figueiredo, Ana Claudia Morais Godoy Silva, Silva, Everton Nunes da Pereira, Maurício Gomes Diabetes Insulina Background The comparison between long acting insulin analogues (LAIA) and human insulin (NPH) has been investigated for decades, with many randomized controlled trials (RCTs) and systematic reviews giving mixed results. This overlapping and contradictory evidence has increased uncertainty on coverage decisions at health systems level. Aim To conduct an overview of systematic reviews and update existing reviews, preparing new meta-analysis to determine whether LAIA are effective for T1D patients compared to NPH.Methods We identified systematic reviews of RCTs that evaluated the efficacy of LAIA glargine or detemir, compared to NPH insulin for T1D, assessing glycated hemoglobin (A1C) and hypoglycemia. Data sources included Pubmed, Cochrane Library, EMBASE and hand-searching. The methodological quality of studies was independently assessed by two reviewers, using AMSTAR and Jadad scale. We found 11 eligible systematic reviews that contained a total of 25 relevant clinical trials. Two reviewers independently abstracted data. Results We found evidence that LAIA are efficacious compared to NPH, with estimates showing a reduction in nocturnal hypoglycemia episodes (RR 0.66; 95% CI 0.57; 0.76) and A1C (95% CI 0.23; 0.12). No significance was found related to severe hypoglycemia (RR 0.94; 95% CI 0.71; 1.24). Conclusion This study design has allowed us to carry out the most comprehensive assessment of RCTs on this subject, filling a gap in diabetes research. Our paper addresses a question that is important not only for decision makers but also for clinicians. 2019-06-04T12:12:54Z 2019-06-04T12:12:54Z 2018 Artigo http://repositorio.unb.br/handle/10482/34687 https://doi.org/10.1371/journal.pone.0194801 Inglês Acesso Aberto © 2018 Laranjeira et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. application/pdf Plos One
institution REPOSITORIO UNB
collection REPOSITORIO UNB
language Inglês
topic Diabetes
Insulina
spellingShingle Diabetes
Insulina
Laranjeira, Fernanda de Oliveira
Andrade, Keitty Regina Cordeiro de
Figueiredo, Ana Claudia Morais Godoy
Silva, Silva, Everton Nunes da
Pereira, Maurício Gomes
Long-acting insulin analogues for type 1 diabetes : an overview of systematic reviews and meta-analysis of randomized controlled trials
description Background The comparison between long acting insulin analogues (LAIA) and human insulin (NPH) has been investigated for decades, with many randomized controlled trials (RCTs) and systematic reviews giving mixed results. This overlapping and contradictory evidence has increased uncertainty on coverage decisions at health systems level. Aim To conduct an overview of systematic reviews and update existing reviews, preparing new meta-analysis to determine whether LAIA are effective for T1D patients compared to NPH.Methods We identified systematic reviews of RCTs that evaluated the efficacy of LAIA glargine or detemir, compared to NPH insulin for T1D, assessing glycated hemoglobin (A1C) and hypoglycemia. Data sources included Pubmed, Cochrane Library, EMBASE and hand-searching. The methodological quality of studies was independently assessed by two reviewers, using AMSTAR and Jadad scale. We found 11 eligible systematic reviews that contained a total of 25 relevant clinical trials. Two reviewers independently abstracted data. Results We found evidence that LAIA are efficacious compared to NPH, with estimates showing a reduction in nocturnal hypoglycemia episodes (RR 0.66; 95% CI 0.57; 0.76) and A1C (95% CI 0.23; 0.12). No significance was found related to severe hypoglycemia (RR 0.94; 95% CI 0.71; 1.24). Conclusion This study design has allowed us to carry out the most comprehensive assessment of RCTs on this subject, filling a gap in diabetes research. Our paper addresses a question that is important not only for decision makers but also for clinicians.
format Artigo
author Laranjeira, Fernanda de Oliveira
Andrade, Keitty Regina Cordeiro de
Figueiredo, Ana Claudia Morais Godoy
Silva, Silva, Everton Nunes da
Pereira, Maurício Gomes
author_sort Laranjeira, Fernanda de Oliveira
title Long-acting insulin analogues for type 1 diabetes : an overview of systematic reviews and meta-analysis of randomized controlled trials
title_short Long-acting insulin analogues for type 1 diabetes : an overview of systematic reviews and meta-analysis of randomized controlled trials
title_full Long-acting insulin analogues for type 1 diabetes : an overview of systematic reviews and meta-analysis of randomized controlled trials
title_fullStr Long-acting insulin analogues for type 1 diabetes : an overview of systematic reviews and meta-analysis of randomized controlled trials
title_full_unstemmed Long-acting insulin analogues for type 1 diabetes : an overview of systematic reviews and meta-analysis of randomized controlled trials
title_sort long-acting insulin analogues for type 1 diabetes : an overview of systematic reviews and meta-analysis of randomized controlled trials
publisher Plos One
publishDate 2019
url http://repositorio.unb.br/handle/10482/34687
https://doi.org/10.1371/journal.pone.0194801
_version_ 1641989040762781696
score 13.657419

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