Newer, older insulin formulations may offer similar glucose-lowering effects

The findings may help inform decisions about insulin therapy for patients with type 2 diabetes, for example, when minimizing weight gain or nocturnal hypoglycemia is a priority.

Newer and older insulin regimens do not substantially differ in their glucose-lowering effects or safety profiles, a study found.

Researchers reviewed 39 randomized trials involving 26,195 patients to compare the efficacy and safety of 10 basal insulin analogues. Findings from the systematic evidence review and meta-analysis were published July 10 by Annals of Internal Medicine.

High- to moderate-quality evidence indicated that detemir caused less weight gain than any other regimen, the meta-analysis found. Glargine, 300 U/mL (Glar-300), had a favorable weight profile compared with degludec, 100 U/mL (Deg-100); degludec, 200 u/mL (Deg-200); thrice-weekly degludec (Deg-3TW); glargine, 100 U/mL (Glar-100); and LY2963016 (glargine biosimilar), the authors reported. Fewer patients treated with Deg-100, Deg-200, and Glar-300 experienced nocturnal hypoglycemia compared with those treated with detemir, Glar-100, LY2963016, and neutral protamine lispro, according to low- and very-low-quality evidence.

No differences between glargine and glargine biosimilars (LY2963016, MK-1293, and MYL-1501D) were seen for reduction in HbA1c level, effect on body weight, or incidence of hypoglycemia, the authors wrote.

Overall, the authors concluded that based on low-quality evidence, basal insulin analogues for type 2 diabetes mellitus do not appear to have substantial differences in glucose-lowering effects. The authors noted that their findings may help inform decisions about insulin therapy for patients with type 2 diabetes. For example, when minimizing weight gain is a priority, detemir or Glar-300 could be considered over other options, they noted. If nocturnal hypoglycemia is the main concern, internists could advise using Deg-100, Deg-200, or Glar-300.

“In addition to short-term efficacy and safety, effects of individual drugs on long-term cardiovascular outcomes and cost-effectiveness data should be considered for optimal therapeutic decision making,” the authors wrote.