Evidence Summary
What is an Evidence Summary?
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.
Related Evidence Summaries
-
Self-monitoring reduces blood-sugar levels in patients with non-insulin-treated Type 2 diabetes
Journal of Diabetes Science and Technology (2018) -
Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus
Cochrane Database of Systematic Reviews (2014) -
Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin
Cochrane Database of Systematic Reviews (2012)
Related Web Resources
-
Prediabetes: Which Treatment Should I Use to Prevent Type 2 Diabetes?
OHRIThis patient decision aid helps People with prediabetes considering treatment to help prevent type 2 diabetes decide on whether to make a major lifestyle change or take the medicine metformin by comparing the benefits, risks, and side effects of both options. -
What should I eat? Types of fat
Harvard School of Public HealthThere are three main types of fat: unsaturated, saturated and trans fat. Unsaturated fats can help improve cholesterol levels and lower inflammation and are found in olive oil, avocados, nuts, seeds and fish. Trans fats are common in fast foods, and can increase your risk of heart disease, stroke, diabetes and other chronic conditions. -
Medication for type 2 diabetes
Informed Health OnlineTalk to your doctor about diabetes medications. Consider your treatment goals, age, weight, health conditions and other medications when deciding if a drug is right for you.
Register for free access to all Professional content
RegisterOur Content
About
Support for the Portal is largely provided by the Labarge Optimal Aging Initiative. AGE-WELL is a contributing partner. Help us to continue to provide direct and easy access to evidence-based information on health and social conditions to help you stay healthy, active and engaged as you grow older. Donate Today.
