Long acting insulin shown to be better than intermediate insulin in type 1 diabetes

Mon, 06 Oct 2014
A comparison of long acting and intermediate insulin, involving 39 different clinical studies, has shown long acting analogue insulin to be the stronger option in people with type 1 diabetes.

The long acting analogue insulin included in the comparison were Lantus (insulin glargine), which has a duration of around 24 hours and is taken once a day, and Levemir (insulin detemir) which has a duration for 18 to 24 hours and is taken either once or twice a day. The comparative insulin, intermediate insulin is NPH (neutral protamine Hagedorn), which usually has a duration of up to 18 hours and is taken twice daily.

Overall, 7,496 people with type 1 diabetes were included in the analysis, which included 39 clinical trials, 26 of which were randomised controlled trials. The researchers analysed effects of the different insulin on HbA1c, weight gain and incidence of severe hypoglycemia.

The analysis showed that average improvements in HbA1c with long acting insulin improved HbA1c between 2.9 mmol/mol (0.26%) and 4.3 mmol/mol (0.39%) compared with NPH insulin. In terms of weight gain, long acting insulin led to less average weight gain, of between 4.0 and 5.5kg, compared with intermediate (NPH) insulin.

In the trials reviewed, Lantus was the most effective long acting insulin in terms of HbA1c reduction, whereas Levemir (once daily) was the most effective in terms of least weight gained. When numbers of severe hypos were reviewed, users of Levemir (either once or twice daily) had a 35% reduction in incidences of severe hypos compared to users of NPH insulin.

The trials showed that whilst long acting insulin analogues are more expensive medications than NPH insulin, the benefit of reductions in HbA1c, weight gain and severe hypoglycemia is likely to outweigh the higher medication costs.
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