Cochrane · systematic review · CD013498
(Ultra‐)long‐acting insulin analogues for people with type 1 diabetes mellitus
Hemmingsen, B, Metzendorf, M-I, Richter, B · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
Metabolic and Endocrine DisordersAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
35
current version
GRADE rated
34
No studies
1
Included studies
NR
No studies 1 · 2.9%Ungraded 0 · 0%Very low 4 · 11.4%Low 20 · 57.1%Moderate 10 · 28.6%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Summary of findings: insulin detemir versus NPH insulin
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Summary of findings: insulin detemir vs NPH insulin | 4.97 [0.79, 31.38] | 9 studies · 3334 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Health‐related quality of life Description: diabetes health profile; insulin therapy‐related quality of life at night (scale not specified) Summary of findings: insulin detemir vs NPH insulin | no estimate extracted | 3 studies · 870 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Severe hypoglycaemia (n/N) Definition: hypoglycaemia requiring third party assistance (Bartley 2008; Kobayashi 2007; NCT00605137; Robertson 2007; Russell‐Jones 2004; Standl 2004; Thalange 2013; Vague 2003); episodes where the children were semi‐co... Summary of findings: insulin detemir vs NPH insulin | RR 0.69 [0.52, 0.92] | 8 studies · 3219 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Non‐fatal myocardial infarction/stroke Definition: myocardial infarction Summary of findings: insulin detemir vs NPH insulin | no estimate extracted | 1 study · 495 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Severe nocturnal hypoglycaemia (n/N) Definition: severe hypoglycaemia occurring 23:00‐06:00 (Bartley 2008; NCT00605137; Russell‐Jones 2004; Standl 2004; Vague 2003); occurring 22:00‐07:00 (Robertson 2007; Thalange 2013) Summary of findings: insulin detemir vs NPH insulin | RR 0.67 [0.39, 1.17] | 7 studies · 2925 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Serious adverse events (n/N) Summary of findings: insulin detemir vs NPH insulin | RR 0.95 [0.75, 1.21] | 9 studies · 3332 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
HbA1c (%) Summary of findings: insulin detemir vs NPH insulin | no estimate extracted | 8 studies · 3122 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Summary of findings: insulin glargine versus NPH insulin
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Summary of findings: insulin glargine vs NPH insulin | 0.14 [0, 6.98] | 8 studies · 2175 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Health‐related quality of life Scales: Well‐Being Enquiry for Diabetics; General Well‐being; Diabetes Quality of Life for Youth and Parents' Diabetes Quality of Life Summary of findings: insulin glargine vs NPH insulin | no estimate extracted | 4 studies · 1013 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Severe hypoglycaemia (n/N) Definition: symptomatic hypoglycaemia requiring third party assistance, with either a blood glucose level < 2.8 mmol/L or prompt recovery after administration of oral carbohydrate, iv glucose or glucagon (Fulcher 2005; H... Summary of findings: insulin glargine vs NPH insulin | RR 0.84 [0.67, 1.04] | 9 studies · 2350 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Non‐fatal myocardial infarction/stroke Definition: myocardial infarction/cerebral ischaemia Summary of findings: insulin glargine vs NPH insulin | no estimate extracted | 1 study · 585 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Severe nocturnal hypoglycaemia (n/N) Definition: severe hypoglycaemia occurring 23:00‐07:00 (PRESCHOOL); severe hypoglycaemia occurring after the evening insulin injection and before the morning insulin dose (Fulcher 2005); severe hypoglycaemia oc... Summary of findings: insulin glargine vs NPH insulin | RR 0.83 [0.62, 1.12] | 6 studies · 1893 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Serious adverse events (n/N) Summary of findings: insulin glargine vs NPH insulin | RR 1.08 [0.63, 1.84] | 8 studies · 2229 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
HbA1c (%) Summary of findings: insulin glargine vs NPH insulin | no estimate extracted | 9 studies · 2285 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Summary of findings: insulin detemir versus insulin glargine
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Summary of findings: insulin detemir vs insulin glargine | no estimate extracted | 2 studies · 763 participants | Low Downgraded: imprecision, inconsistency, indirectness |
Health‐related quality of life Summary of findings: insulin detemir vs insulin glargine | no estimate extracted | NR | No studies |
Severe hypoglycaemia (n/N) Definition: hypoglycaemia requiring third party assistance Summary of findings: insulin detemir vs insulin glargine | RR 0.59 [0.13, 2.63] | 2 studies · 763 participants | Very low Downgraded: imprecision, inconsistency, indirectness |
Non‐fatal myocardial infarction/stroke Definition: non‐fatal myocardial infarction/stroke Summary of findings: insulin detemir vs insulin glargine | no estimate extracted | 1 study · 443 participants | Low Downgraded: imprecision, inconsistency, indirectness |
Severe nocturnal hypoglycaemia (n/N) Definition: severe hypoglycaemia occurring from 11 p.m. to 6 a.m. Summary of findings: insulin detemir vs insulin glargine | RR 0.55 [0.06, 5.12] | 2 studies · 763 participants | Very low Downgraded: imprecision, inconsistency, indirectness |
Serious adverse events (n/N) Summary of findings: insulin detemir vs insulin glargine | RR 1.72 [0.91, 3.28] | 2 studies · 763 participants | Low Downgraded: imprecision, inconsistency, indirectness |
HbA1c (%) Summary of findings: insulin detemir vs insulin glargine | no estimate extracted | 2 studies · 763 participants | Low Downgraded: imprecision, inconsistency, indirectness |
Summary of findings: insulin degludec versus insulin detemir
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Summary of findings: insulin degludec vs insulin detemir | no estimate extracted | 2 studies · 802 participants | Low Downgraded: imprecision, indirectness |
Health‐related quality of life Scale: Short‐Form 36 version 2 (higher values mean better health‐related quality of life) Summary of findings: insulin degludec vs insulin detemir | no estimate extracted | 1 study · 454 participants | Low Downgraded: risk of bias, imprecision |
Severe hypoglycaemia (n/N) Definition: hypoglycaemia requiring third party assistance (Davies 2014) or altered mental status and cannot assist in their own care, is semiconscious or unconscious, or in a coma ± convulsions and may require parentera... Summary of findings: insulin degludec vs insulin detemir | RR 1.17 [0.81, 1.69] | 2 studies · 802 participants | Low Downgraded: imprecision |
Non‐fatal myocardial infarction/stroke Definition: non‐fatal myocardial infarction/stroke Summary of findings: insulin degludec vs insulin detemir | no estimate extracted | 1 study · 453 participants | Low Downgraded: imprecision, indirectness |
Severe nocturnal hypoglycaemia (n/N) Definition: severe hypoglycaemia occurring 00:01‐05:59 (Davies 2014) or 23:00‐07:00 (BEGIN Young) Summary of findings: insulin degludec vs insulin detemir | RR 1.12 [0.51, 2.46] | 2 studies · 802 participants | Low Downgraded: imprecision |
Serious adverse events (n/N) Summary of findings: insulin degludec vs insulin detemir | RR 1.25 [0.76, 2.05] | 2 studies · 802 participants | Low Downgraded: imprecision |
HbA1c (%) Summary of findings: insulin degludec vs insulin detemir | no estimate extracted | 2 studies · 802 participants | Low Downgraded: imprecision |
Summary of findings: insulin degludec versus insulin glargine
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Summary of findings: insulin degludec vs insulin glargine | Peto OR 1.34 [0.15, 11.93] | 3 studies · 973 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Health‐related quality of life Scale: Short‐Form 36 version 2 (higher values mean better health‐related quality of life) Summary of findings: insulin degludec vs insulin glargine | no estimate extracted | 2 studies · 1042 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Severe hypoglycaemia (n/N) Definition: hypoglycaemia requiring third party assistance (BEGIN Flex T1; BEGIN Young) or an event associated with impaired consciousness or seizure (Urakami 2017) Summary of findings: insulin degludec vs insulin glargine | RR 1.22 [0.82, 1.82] | 3 studies · 970 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Non‐fatal myocardial infarction/stroke Definition: non‐fatal myocardial infarction/cerebral ischaemia Summary of findings: insulin degludec vs insulin glargine | no estimate extracted | 3 studies · 970 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Severe nocturnal hypoglycaemia (n/N) Definition: severe hypoglycaemia occurring from 22:00 to 06:59 h Summary of findings: insulin degludec vs insulin glargine | RR 1.39 [0.59, 3.27] | 3 studies · 970 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Serious adverse events (n/N) Summary of findings: insulin degludec vs insulin glargine | RR 0.92 [0.58, 1.46] | 3 studies · 970 participants | Low Downgraded: risk of bias, imprecision, indirectness |
HbA1c (%) Summary of findings: insulin degludec vs insulin glargine | no estimate extracted | 4 studies · 1388 participants | Low Downgraded: risk of bias, imprecision, indirectness |