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, 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

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 A1c compared 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.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: this was work funded by the Canadian Institutes for Health Research; no financial relationships with any organization that might have an interest in the submitted work in the previous three years; no relationships or activities that could appear to have influenced the submitted work.

© Tricco et al 2014.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4817932/bin/tria020305.f1_default.jpg
Fig 1 Study flow
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4817932/bin/tria020305.f2_default.jpg
Fig 2 Network meta-analysis estimates for glycated hemoglobin (26 randomized clinical trials including 6776 patients). bid=twice daily; od=once daily; qid=four times daily

References

    1. Valensi P, Cosson E. Is insulin detemir able to favor a lower variability in the action of injected insulin in diabetic subjects? Diabetes Metab 2005;31:4S34-9.
    1. Monami M, Marchionni N, Mannucci E. Long-acting insulin analogues vs. NPH human insulin in type 1 diabetes: a meta-analysis. Diabetes Obes Metab 2009;11:372-8.
    1. Sanches AC, Correr CJ, Venson R, Pontarolo R. Revisiting the efficacy of long-acting insulin analogues on adults with type 1 diabetes using mixed-treatment comparisons. Diabetes Res Clin Pract 2011;94:333-9.
    1. Vardi M, Jacobson E, Nini A, Bitterman H. Intermediate acting versus long acting insulin for type 1 diabetes mellitus. Cochrane Database Syst Rev 2008;3:CD006297.
    1. Cameron CG, Bennett HA. Cost-effectiveness of insulin analogues for diabetes mellitus. CMAJ 2009;180:400-7.
    1. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M. Reporting guidelines for systematic review protocols. 9th Cochrane Colloquium, Madrid, Spain, 2011.
    1. Tricco AC, Ashoor HM, Soobiah C, Hemmelgarn B, Moher D, Hutton B, et al. Safety, effectiveness, and cost of long-acting versus intermediate-acting insulin for type 1 diabetes: protocol for a systematic review and network meta-analysis. Syst Rev 2013;2(1):73.
    1. Tricco A, Ashoor H, Soobiah C, Hemmelgarn B, Moher D, Hutton B, et al. Safety, effectiveness, and cost of long acting versus intermediate acting insulin for type 1 diabetes: protocol for a systematic review and network meta-analysis. 2013. .
    1. Sampson M, McGowan J, Cogo E, Grimshaw J, Moher D, Lefebvre C. An evidence-based practice guideline for the peer review of electronic search strategies. J Clin Epidemiol 2009;62:944-52.
    1. Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for economic health evaluation of health care programmes. 3rd ed. Oxford University Press, 2005.
    1. Higgins JP, Altman DG, Gotzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
    1. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. .
    1. Santaguida PL, Raina P. McMaster Quality Assessment Scale of Harms (McHarm) for primary studies. 2008. .
    1. Raudenbush SW. Analyzing effect sizes: random effects models. In: Cooper HM, Hedges LV, Valentine JC, eds. The handbook of research synthesis and meta-analysis. 2nd ed. Russell Sage Foundation, 2009:295-315.
    1. Salanti G. Indirect and mixed-treatment comparison, network, or multiple-treatments meta-analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool. Res Synth Method 2012;3:80-97.
    1. White IR, Barrett JK, Jackson D, Higgins JPT. Consistency and inconsistency in network meta-analysis: model estimation using multivariate meta-regression. Res Synth Method 2012;3:111-25.
    1. Song F, Altman DG, Glenny AM, Deeks JJ. Validity of indirect comparison for estimating efficacy of competing interventions: empirical evidence from published meta-analyses. BMJ 2003;326:472.
    1. Chaimani A, Higgins JP, Mavridis D, Spyridonos P, Salanti G. Graphical tools for network meta-analysis in STATA. PloS One 2013;8:e76654.
    1. Riley RD, Higgins JP, Deeks JJ. Interpretation of random effects meta-analyses. BMJ 2011;342:d549.
    1. Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol 2011;64:163-71.
    1. Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw 2010;36(3):1-48.
    1. White IR. Multivariate random-effects meta-regression: updates to mvmeta. Stata J 2011;11:255-70.
    1. OANDA. Historical exchange rates. 2013. .
    1. United States Department of Labor. Consumer price index. 2013. .
    1. Mathiesen ER, Hod M, Ivanisevic M, Duran Garcia S, Brøndsted L, Jovanovic L, et al. Maternal efficacy and safety outcomes in a randomized, controlled trial comparing insulin detemir with NPH insulin in 310 pregnant women with type 1 diabetes. Diabetes Care 2012;35:2012-7.
    1. Renard E, Dubois-Laforgue D, Guerci B, for the Variability Study Group. Non-inferiority of insulin glargine versus insulin detemir on blood glucose variability in type 1 diabetes patients: a multicenter, randomized, crossover study. Diabetes Technol Ther 2011;13:1213-8.
    1. Zachariah S, Sheldon B, Shojaee-Moradie F, Jackson NC, Backhouse K, Johnsen S, et al. Insulin detemir reduces weight gain as a result of reduced food intake in patients with type 1 diabetes. Diabetes Care 2011;34:1487-91.
    1. Heller S, Koenen C, Bode B. Comparison of insulin detemir and insulin glargine in a basal-bolus regimen, with insulin aspart as the mealtime insulin, in patients with type 1 diabetes: a 52-week, multinational, randomized, open-label, parallel-group, treat-to-target noninferiority trial. Clinical Ther 2009;31:2086-97.
    1. Le Floch JP, Levy M, Mosnier-Pudar H, Nobels F, Laroche S, Gonbert S, et al. Comparison of once- versus twice-daily administration of insulin detemir, used with mealtime insulin aspart, in basal-bolus therapy for type 1 diabetes: assessment of detemir administration in a progressive treat-to-target trial (ADAPT). Diabetes Care 2009;32:32-7.
    1. Bartley PC, Bogoev M, Larsen J, Philotheou A. Long-term efficacy and safety of insulin detemir compared to neutral protamine Hagedorn insulin in patients with type 1 diabetes using a treat-to-target basal-bolus regimen with insulin aspart at meals: a 2-year, randomized, controlled trial. Diabet Med 2008;25:442-9.
    1. Bolli GB, Songini M, Trovati M, Del Prato S, Ghirlanda G, Cordera R, et al. Lower fasting blood glucose, glucose variability and nocturnal hypoglycaemia with glargine vs NPH basal insulin in subjects with type 1 diabetes. Nutr Metab Cardiovasc Dis 2009;19:571-9.
    1. Chatterjee S, Jarvis-Kay J, Rengarajan T, Lawrence IG, McNally PG, Davies MJ. Glargine versus NPH insulin: efficacy in comparison with insulin aspart in a basal bolus regimen in type 1 diabetes—the glargine and aspart study (GLASS) a randomised cross-over study. Diabetes Res Clin Pract 2007;77:215-22.
    1. Pesic M, Zivic S, Radenkovic S, Velojic M, Dimic D, Antic S. [Comparison between basal insulin glargine and NPH insulin in patients with diabetes type 1 on conventional intensive insulin therapy] [Serbian]. Vojnosanit Pregl 2007;64:247-52.
    1. Philippo H, Novo Nordisk. Efficacy and safety of insulin detemir in type 1 diabetes. 2007. .
    1. Pieber TR, Treichel HC, Hompesch B, Philotheou A, Mordhorst L, Gall MA, et al. Comparison of insulin detemir and insulin glargine in subjects with type 1 diabetes using intensive insulin therapy. Diabet Med 2007;24:635-42.
    1. Radman M, Jurisic D, Ljutic D, Jerkovic R, Kovacic N, Hozo IS. Assessing glycemia in type 1 diabetic patients using a microdialysis system for continuous glucose monitoring. Ann Saudi Med 2007;27:166-70.
    1. Ashwell SG, Gebbie J, Home PD. Twice-daily compared with once-daily insulin glargine in people with type 1 diabetes using meal-time insulin aspart. Diabet Med 2006;23:879-86.
    1. Kolendorf K, Ross GP, Pavlic-Renar I, Perriello G, Philotheou A, Jendle J, et al. Insulin detemir lowers the risk of hypoglycaemia and provides more consistent plasma glucose levels compared with NPH insulin in type 1 diabetes. Diabet Med 2006;23:729-35.
    1. De Leeuw I, Vague P, Selam JL, Skeie S, Lang H, Draeger E, et al. Insulin detemir used in basal-bolus therapy in people with type 1 diabetes is associated with a lower risk of nocturnal hypoglycaemia and less weight gain over 12 months in comparison to NPH insulin. Diabetes Obes Metab 2005;7:73-82.
    1. Fulcher GR, Gilbert RE, Yue DK. Glargine is superior to neutral protamine Hagedorn for improving glycated haemoglobin and fasting blood glucose levels during intensive insulin therapy. Intern Med J 2005;35:536-42.
    1. Pieber TR, Draeger E, Kristensen A, Grill V. Comparison of three multiple injection regimens for type 1 diabetes: morning plus dinner or bedtime administration of insulin detemir vs. morning plus bedtime NPH insulin. Diabet Med 2005;22:850-7.
    1. Home P, Bartley P, Russell-Jones D, Hanaire-Broutin H, Heeg JE, Abrams P, et al. Insulin detemir offers improved glycemic control compared with NPH insulin in people with type 1 diabetes: a randomized clinical trial. Diabetes Care 2004;27:1081-7.
    1. Porcellati F, Rossetti P, Pampanelli S, Fanelli CG, Torlone E, Scionti L, et al. Better long-term glycaemic control with the basal insulin glargine as compared with NPH in patients with type 1 diabetes mellitus given meal-time lispro insulin. Diabet Med 2004;21:1213-20.
    1. Russell-Jones D, Simpson R, Hylleberg B, Draeger E, Bolinder J. Effects of QD insulin detemir or neutral protamine Hagedorn on blood glucose control in patients with type I diabetes mellitus using a basal-bolus regimen. Clin Ther 2004;26:724-36.
    1. Standl E, Lang H, Roberts A. The 12-month efficacy and safety of insulin detemir and NPH insulin in basal-bolus therapy for the treatment of type 1 diabetes. Diabetes Technol Ther 2004;6:579-88.
    1. Rossetti P, Pampanelli S, Fanelli C, Porcellati F, Costa E, Torlone E, et al. Intensive replacement of basal insulin in patients with type 1 diabetes given rapid-acting insulin analog at mealtime: a 3-month comparison between administration of NPH insulin four times daily and glargine insulin at dinner or bedtime. Diabetes Care 2003;26:1490-6.
    1. Vague P, Selam JL, Skeie S, De Leeuw I, Elte JW, Haahr H, et al. Insulin detemir is associated with more predictable glycemic control and reduced risk of hypoglycemia than NPH insulin in patients with type 1 diabetes on a basal-bolus regimen with premeal insulin aspart. Diabetes Care 2003;26:590-6.
    1. Pieber TR, Eugene-Jolchine I, Derobert E. Efficacy and safety of HOE 901 versus NPH insulin in patients with type 1 diabetes. Diabetes Care 2000;23:157-62.
    1. Raskin P, Klaff L, Bergenstal R, Halle JP, Donley D, Mecca T. A 16-week comparison of the novel insulin analog insulin glargine (HOE 901) and NPH human insulin used with insulin lispro in patients with type 1 diabetes. Diabetes Care 2000;23:1666-71.
    1. Ratner RE, Hirsch IB, Neifing JL, Garg SK, Mecca TE, Wilson CA. Less hypoglycemia with insulin glargine in intensive insulin therapy for type 1 diabetes. Diabetes Care 2000;23:639-43.
    1. Rosenstock J, Park G, Zimmerman J, for the U.S. Insulin Glargine (HOE 901) Type 1 Diabetes Investigator Group. Basal insulin glargine (HOE 901) versus NPH insulin in patients with type 1 diabetes on multiple daily insulin regimens. Diabetes Care 2000;23:1137-42.
    1. Currie CJ, Poole CD, Tetlow T, Holmes P, McEwan P. The outcome of care in people with type 1 and type 2 diabetes following switching to treatment with either insulin glargine or insulin detemir in routine general practice in the UK: a retrospective database analysis. Curr Med Res Opin 2007;23(s1):S33-9.
    1. Pfohl M, Schadlich PK, Dippel FW, Koltermann KC. Health economic evaluation of insulin glargine vs NPH insulin in intensified conventional therapy for type 1 diabetes in Germany. J Med Econ 2012;15(suppl 2):14-27.
    1. Valentine WJ, Jendle J, Saraheimo M, Thorsteinsson B, Pollock RF, Lammert M. Evaluating the cost-effectiveness of reduced mild hypoglycaemia in subjects with type 1 diabetes treated with insulin detemir or NPH insulin in Denmark, Sweden, Finland and the Netherlands. Diabet Med 2012;29:303-12.
    1. Valentine WJ, Aagren M, Haglund M, Ericsson A, Gschwend MH. Evaluation of the long-term cost-effectiveness of insulin detemir compared with neutral protamine hagedorn insulin in patients with type 1 diabetes using a basal-bolus regimen in Sweden. Scand J Public Health 2011;39:79-87.
    1. Greiner RA, Azoulay M, Brandle M. Cost-effectiveness of insulin glargine versus NPH insulin for the treatment of type 1 and type 2 diabetes modeling the interaction between hypoglycemia and glycemic control in Switzerland. 69th American Diabetes Association (ADA) Scientific Sessions, New Orleans, Louisiana, 2009.
    1. Gschwend MH, Aagren M, Valentine WJ. Cost-effectiveness of insulin detemir compared with neutral protamine Hagedorn insulin in patients with type 1 diabetes using a basal-bolus regimen in five European countries. J Med Econ 2009;12:114-23.
    1. Tunis SL, Minshall ME, Conner C, McCormick JI, Kapor J, Yale JF, et al. Cost-effectiveness of insulin detemir compared to NPH insulin for type 1 and type 2 diabetes mellitus in the Canadian payer setting: modeling analysis. Curr Med Res Opin 2009;25:1273-84.
    1. Grima DT, Thompson MF, Sauriol L. Modelling cost effectiveness of insulin glargine for the treatment of type 1 and 2 diabetes in Canada. Pharmacoeconomics 2007;25:253-66.
    1. McEwan PP, Poole CD, Tetlow T, Holmes P, Currie CJ. Evaluation of the cost-effectiveness of insulin glargine versus NPH insulin for the treatment of type 1 diabetes in the UK. Curr Med Res Opin 2007;23(s1):S7-19.
    1. Valentine WJ, Palmer AJ, Erny-Albrecht KM, Ray JA, Cobden D, Foos V, et al. Cost-effectiveness of basal insulin from a US health system perspective: comparative analyses of detemir, glargine, and NPH. Adv Ther 2006;23:191-207.
    1. Hershon KS, Blevins TC, Mayo CA, Rosskamp R. Once-daily insulin glargine compared with twice-daily NPH insulin in patients with type 1 diabetes. Endocr Pract 2004;10:10-7.
    1. Tran K, Banerjee S, Li H, Noorani HZ, Mensinkai S, Dooley K, et al. Long-acting insulin analogues for diabetes mellitus: meta-analysis of clinical outcomes and assessment of costeffectiveness. Canadian Agency for Drugs and Technologies in Health, 2007. (Technology report number 92).
    1. Kobayashi M, Iwamoto Y, Kaku K. 48-week randomized multicenter open-label parallel group phase 3 trial to compare insulin detemir and NPH insulin efficacy and safety in subjects with insulin-requiring diabetes mellitus in a basal-bolus regimen [Japanese, English abstract]. J Jpn Diabetes Soc 2007;50:649-63.

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