Prescribing Advice for GPs

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Newer insulins no better

The Journal of the Canadian Medical Association has published the results of a meta-analysis that aimed to assess the efficacy and safety of insulin analogues for the management of diabetes mellitus.

This analysis updated two previous analyses. This review identified 5 new studies of rapid-acting insulin analogues and 22 new studies of long-acting insulin analogues.

The review compared HbA1c results for newer insulins compared to conventional insulins in both type 1 and type 2 diabetes. The differences were minimal and inconsistent.

Type 1 diabetes:

  • Lispro -0.09%, 95% confidence interval [CI] –0.16% to –0.02%
  • Aspart -0.19%, 95% CI –0.20% to –0.07%
  • Glargine -0.11%, 95% CI –0.21% to –0.02%
  • Detemir -0.06% (not significant)

Type 2 diabetes:

  • Lispro -0.03% (not significant)
  • Aspart -0.09% (not significant)
  • Glargine -0.05% (not significant)
  • Detemir +0.13%, 95% CI +0.03% to +0.22%

The analysis could not draw any conclusions with respect to reductions in long-term diabetes-related complications or death due to insufficient data. Reductions in hypoglycaemia are also inconsistent.

The authors conclude that, "insulin analogues offer little benefit relative to conventional insulins in terms of glycaemic control or reduced hypoglycaemia". They also recommend long-term high quality studies to determine efficacy in diabetes-related complications.

Action: When treatment with insulin therapy is necessary consideration should be given to the available alternatives. Insulin analogues may be useful in selected patients, for example those who experience nocturnal hypoglycaemia.

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