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Basal Insulin Analogues: Are They That Different?

Are basal insulin analogues all that different from each other in their glucose-lowering effects? According to a new study, not really. 

Reference: Madenidou AV, Paschos P, Karagiannis T, et al. Comparative benefits and harms of basal insulin analogues for type 2 diabetes: A systematic review and network meta-analysis. Ann Intern Med. 2018;169:165-174.

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Anastasia-Vasiliki Madenidou, MD, MSc, and colleagues in Greece and the United Kingdom found that available basal insulin analogues for type 2 diabetes mellitus (T2DM) do not substantially differ in their glucose-lowering effects. Click through the slides above for details on their meta-analysis and take home points for physicians.

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Basal Insulin Analogues and T2DM. Authors of the study assessed the comparative efficacy and safety of basal insulin analogues for adults with T2DM. 

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The Study. The authors conducted a search of randomized controlled trials that lasted at least 12 weeks that compared basal insulin analogues in adult T2DM patients. The levels of evidence were established and reported as confidence levels agreed upon which were high, moderate, low, or very low. 

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Results:

  • Deg-3TW was less effective at reducing A1c vs Deg-100, Deg-200, Glar-100, Glar-300, and LY2963016
  • Detemir was inferior to Glar-100, Glar-300 and had most favorable weight profile vs all other drugs
  • More patients treated with Glar-100 achieved A1c <7% vs Deg-3TW, detemir, or NPL
  • Patients treated with Glar-300 had less weight gain vs Deg-100, Deg-200, Glar-100, or LY2963016
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Results (Hypoglycemia):

  • No differences in incidence of any hypoglycemia among basal insulin regimens (except Deg-100)
  • Deg-100, Deg-200, Glar-300 associated with lower incidence of nocturnal hypoglycemia vs detemir, Glar-100, LY2963016, NPL
  • NPL associated with an increased risk for nocturnal hypoglycemia vs all other drugs (except Deg-3TW)
  • Incidence of severe hypoglycemia did not differ among most insulin regimens, except NPL which was associated with an increased risk
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Take Home Points:

  • Differences in glycemic efficacy among basal insulin analogues was minimal, lacked clinical significance
  • With the exception of NPL, no differences seen in risk for severe hypoglycemia with the other insulin analogues
  • Base treatment choices among basal insulin analogues in T2DM on clinically relevant parameters that are most important
  • Detemir, Glar-300 should be considered weighing any potential contraindications where weight gain is of particular concern
  • Evidence presented is low-quality and indirect, should be considered part of broader strategy for glucose management 
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