Madenidou AV, et al. - The comparative efficacy and safety of basal insulin analogues for adults with type 2 diabetes mellitus (T2DM) were evaluated in this analysis. As per low-quality evidence, basal insulin analogues for T2DM did not substantially vary in their glucose-lowering effect. Low- and very-low-quality evidence proposed some regimens might be correlated with lower risk for nocturnal hypoglycemia or less weight gain.

Methods

• For this investigation, the researchers searched several databases from inception to April 2018 without language restrictions, ClinicalTrials.gov to April 2018, references of reviews, and meeting abstract books.
• Criteria for study selection were randomized trials lasting at least 12 weeks that compared efficacy (change in hemoglobin A_1c [HbA_1c] level from baseline [primary outcome]; percentage of patients with HbA_1c level <7% at end of study and change in body weight [secondary outcomes]) and safety (hypoglycemia) of basal insulin analogues.
• After that, 2 authors independently extracted data and evaluated risk of bias for each outcome.
• Finally, all authors assessed overall confidence in the evidence.

Results

• According to the findings obtained, 39 trials (26,195 patients) evaluated 10 basal insulin analogues.
• Low- to very-low-quality evidence suggested that thrice-weekly degludec (Deg-3TW) was inferior to most other regimens for decreasing HbA_1c level, with mean differences ranging from 0.21% (vs degludec, 100 U/mL [Deg-100]) to 0.32% (vs glargine, 300 U/mL [Glar-300]).
• High- to moderate-quality evidence indicated that detemir had a favorable weight profile vs all comparators, and Glar-300 was correlated with less weight gain than glargine, 100 U/mL (Glar-100); Deg-100; degludec, 200 U/mL (Deg-200); Deg-3TW; and LY2963016.
• Low- and very-low-quality evidence indicated that Deg-100, Deg-200, and Glar-300 were linked to lower incidence of nocturnal hypoglycemia than detemir, Glar-100, LY2963016, and neutral protamine lispro (NPL).
• Findings revealed that incidence of severe hypoglycemia did not differ among regimens, except NPL, which was related to increased risk vs Deg-100, detemir, Glar-100, and Glar-300.