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Meta-Analysis
. 2011 Jul 6;2011(7):CD006383.
doi: 10.1002/14651858.CD006383.pub2.

Insulin detemir versus insulin glargine for type 2 diabetes mellitus

Sanne G Swinnen  1 , Airin Cr Simon, Frits Holleman, Joost B Hoekstra, J Hans Devries
Affiliations
Meta-Analysis

Insulin detemir versus insulin glargine for type 2 diabetes mellitus

Sanne G Swinnen et al. Cochrane Database Syst Rev. .

Abstract

Background: Chronically elevated blood glucose levels are associated with significant morbidity and mortality. Many diabetes patients will eventually require insulin treatment to maintain good glycaemic control. There are still uncertainties about the optimal insulin treatment regimens for type 2 diabetes, but the long-acting insulin analogues seem beneficial. Several reviews have compared either insulin detemir or insulin glargine to NPH insulin, but research directly comparing both insulin analogues is limited.

Objectives: To assess the effects of insulin detemir and insulin glargine compared with each other in the treatment of type 2 diabetes mellitus.

Search strategy: We searched MEDLINE, EMBASE, The Cochrane Library, online registries of ongoing trials and abstract books. Date of last search was January 2011.

Selection criteria: All randomised controlled trials comparing insulin detemir with insulin glargine with a duration of 12 weeks or longer were included.

Data collection and analysis: Two authors independently selected the studies and extracted the data. Pooling of studies by means of random-effects meta-analysis was performed.

Main results: This review examined four trials lasting 24 to 52 weeks involving 2250 people randomised to either insulin detemir or glargine. Overall, risk of bias of the evaluated studies was high. Insulin glargine was dosed once-daily in the evening. Insulin detemir was initiated once-daily in the evening with the option of an additional dose in the morning in three studies and initiated twice-daily in one study. Of randomised patients 13.6% to 57.2% were injecting insulin detemir twice-daily at the end of trial.Glycaemic control, measured by glycosylated haemoglobin A1c (HbA1c) and HbA1c equal to or less than 7% with or without hypoglycaemia, did not differ statistically significantly between treatment groups.The results showed no significant differences in overall, nocturnal and severe hypoglycaemia between treatment groups.Insulin detemir was associated with less weight gain. Treatment with insulin glargine resulted in a lower daily basal insulin dose and a lower number of injection site reactions.There was no significant difference in the variability of FPG or glucose values in 24-hour profiles between treatment groups. It was not possible to draw conclusions on quality of life, costs or mortality. Only one trial reported results on health-related quality of life and showed no significant differences between treatment groups.

Authors' conclusions: Our analyses suggest that there is no clinically relevant difference in efficacy or safety between insulin detemir and insulin glargine for targeting hyperglycaemia. However, to achieve the same glycaemic control insulin detemir was often injected twice-daily in a higher dose but with less weight gain, while insulin glargine was injected once-daily, with somewhat fewer injection site reactions.

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Conflict of interest statement

Our research group co‐developed the protocol for, conducted and reported one of the included randomised controlled trials. This study was sponsored by Sanofi‐Aventis. We have performed various studies on insulin therapy and other glucose‐lowering interventions in cooperation with Novo Nordisk.

Figures

1
1
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Detemir versus Glargine, Outcome 1 HbA1c at study endpoint.
1.2
1.2. Analysis
Comparison 1 Detemir versus Glargine, Outcome 2 Change in HbA1c.
1.3
1.3. Analysis
Comparison 1 Detemir versus Glargine, Outcome 3 Percentage of participants achieving HbA1c ≤7%.
1.4
1.4. Analysis
Comparison 1 Detemir versus Glargine, Outcome 4 Percentage of participants achieving HbA1c ≤ 7% without hypoglycaemia.
1.5
1.5. Analysis
Comparison 1 Detemir versus Glargine, Outcome 5 Fasting plasma glucose at study endpoint.
1.6
1.6. Analysis
Comparison 1 Detemir versus Glargine, Outcome 6 Change in fasting plasma glucose.
1.7
1.7. Analysis
Comparison 1 Detemir versus Glargine, Outcome 7 Percentage of participants having at least one hypoglycaemic event.
1.8
1.8. Analysis
Comparison 1 Detemir versus Glargine, Outcome 8 Event rate for overall hypoglycaemia per patient‐year.
1.9
1.9. Analysis
Comparison 1 Detemir versus Glargine, Outcome 9 Percentage of participants having at least one nocturnal hypoglycaemic event.
1.10
1.10. Analysis
Comparison 1 Detemir versus Glargine, Outcome 10 Event rate for nocturnal hypoglycaemia per patient‐year.
1.11
1.11. Analysis
Comparison 1 Detemir versus Glargine, Outcome 11 Percentage of participants having at least one severe hypoglycaemic event.
1.12
1.12. Analysis
Comparison 1 Detemir versus Glargine, Outcome 12 Event rate for severe hypoglycaemia per patient‐year.
1.13
1.13. Analysis
Comparison 1 Detemir versus Glargine, Outcome 13 Weight gain.
1.14
1.14. Analysis
Comparison 1 Detemir versus Glargine, Outcome 14 Percentage of participants having at least one injection site reaction.
1.15
1.15. Analysis
Comparison 1 Detemir versus Glargine, Outcome 15 Daily basal insulin dose in units per kg.
1.16
1.16. Analysis
Comparison 1 Detemir versus Glargine, Outcome 16 Variability of fasting plasma glucose at study endpoint.
1.17
1.17. Analysis
Comparison 1 Detemir versus Glargine, Outcome 17 Variability of plasma glucose profiles at study endpoint.
See this image and copyright information in PMC

Comment in

References

References to studies included in this review

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References to studies excluded from this review

King 2009 {published data only}
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Klein 2007 {published data only}
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Lucidi 2010 {published data only}
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References to ongoing studies

NCT00656422 {published data only}
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NCT00699686 {published data only}
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    1. Effects of basal insulin analogue detemir on body composition, epicardial fat and energy metabolism. ClinicalTrials.gov 2009.
NCT00909480 {published data only}
    1. A 26‐week randomised, multinational, open‐labelled, 2‐armed, parallel group, treat‐to‐target once‐daily treatment trial with insulin detemir versus insulin glargine, both in combination with metformin in subjects with type 2 diabetes. ClinicalTrials.gov 2009.

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