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Efficacy of Insulin Analogs in Achieving the Hemoglobin A(1c) Target of <7% in Type 2 Diabetes: Meta-analysis of randomized controlled trials

OBJECTIVE: Insulin analogs are increasingly used in patients with type 2 diabetes. We compared the effect of basal, biphasic, prandial, and basal-bolus insulin regimens with insulin analogs to reach the hemoglobin A(1c) (HbA(1c)) target of <7% in people with type 2 diabetes. RESEARCH DESIGN AND M...

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Detalles Bibliográficos
Autores principales: Giugliano, Dario, Maiorino, Maria Ida, Bellastella, Giuseppe, Chiodini, Paolo, Ceriello, Antonio, Esposito, Katherine
Formato: Texto
Lenguaje:English
Publicado: American Diabetes Association 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024378/
https://www.ncbi.nlm.nih.gov/pubmed/21216850
http://dx.doi.org/10.2337/dc10-1710
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author Giugliano, Dario
Maiorino, Maria Ida
Bellastella, Giuseppe
Chiodini, Paolo
Ceriello, Antonio
Esposito, Katherine
author_facet Giugliano, Dario
Maiorino, Maria Ida
Bellastella, Giuseppe
Chiodini, Paolo
Ceriello, Antonio
Esposito, Katherine
author_sort Giugliano, Dario
collection PubMed
description OBJECTIVE: Insulin analogs are increasingly used in patients with type 2 diabetes. We compared the effect of basal, biphasic, prandial, and basal-bolus insulin regimens with insulin analogs to reach the hemoglobin A(1c) (HbA(1c)) target of <7% in people with type 2 diabetes. RESEARCH DESIGN AND METHODS: We conducted an electronic search for randomized controlled trials (RCTs) involving insulin analogs. RCTs were included if they lasted at least 12 weeks, reported the proportion of diabetic patients reaching the HbA(1c) target of <7% (primary outcome), and the number of patients in any arm was >30. RESULTS: We found 16 RCTs, with 20 comparisons and 7,759 patients. A greater proportion of patients achieved the HbA(1c) goal of <7% with both biphasic (odds ratio 1.88 [95% CI 1.38–2.55]) and prandial (2.07 [1.16–3.69]) insulin compared with basal insulin; this was associated for biphasic insulin with greater hypoglycemia (event/patient/30 days, mean difference, 0.34 [range 0–0.69]) and weight gain in kg (1.0 kg [0.28–1.73]). Compared with biphasic insulin, the basal-bolus regimen was associated with a greater chance to reach the HbA(1c) goal (odds ratio 1.75 [95% CI 1.11–2.77]), with no greater hypoglycemia or weight gain. The effect of insulin analogs on long-term diabetes complications is still lacking. CONCLUSIONS: A greater proportion of type 2 diabetic patients can achieve the HbA(1c) goal <7% with biphasic or prandial insulin compared with basal insulin; in absolute terms, the basal-bolus regimen was best for the attainment of the HbA(1c) goal.
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spelling pubmed-30243782012-02-01 Efficacy of Insulin Analogs in Achieving the Hemoglobin A(1c) Target of <7% in Type 2 Diabetes: Meta-analysis of randomized controlled trials Giugliano, Dario Maiorino, Maria Ida Bellastella, Giuseppe Chiodini, Paolo Ceriello, Antonio Esposito, Katherine Diabetes Care Reviews/Commentaries/ADA Statements OBJECTIVE: Insulin analogs are increasingly used in patients with type 2 diabetes. We compared the effect of basal, biphasic, prandial, and basal-bolus insulin regimens with insulin analogs to reach the hemoglobin A(1c) (HbA(1c)) target of <7% in people with type 2 diabetes. RESEARCH DESIGN AND METHODS: We conducted an electronic search for randomized controlled trials (RCTs) involving insulin analogs. RCTs were included if they lasted at least 12 weeks, reported the proportion of diabetic patients reaching the HbA(1c) target of <7% (primary outcome), and the number of patients in any arm was >30. RESULTS: We found 16 RCTs, with 20 comparisons and 7,759 patients. A greater proportion of patients achieved the HbA(1c) goal of <7% with both biphasic (odds ratio 1.88 [95% CI 1.38–2.55]) and prandial (2.07 [1.16–3.69]) insulin compared with basal insulin; this was associated for biphasic insulin with greater hypoglycemia (event/patient/30 days, mean difference, 0.34 [range 0–0.69]) and weight gain in kg (1.0 kg [0.28–1.73]). Compared with biphasic insulin, the basal-bolus regimen was associated with a greater chance to reach the HbA(1c) goal (odds ratio 1.75 [95% CI 1.11–2.77]), with no greater hypoglycemia or weight gain. The effect of insulin analogs on long-term diabetes complications is still lacking. CONCLUSIONS: A greater proportion of type 2 diabetic patients can achieve the HbA(1c) goal <7% with biphasic or prandial insulin compared with basal insulin; in absolute terms, the basal-bolus regimen was best for the attainment of the HbA(1c) goal. American Diabetes Association 2011-02 2011-01-20 /pmc/articles/PMC3024378/ /pubmed/21216850 http://dx.doi.org/10.2337/dc10-1710 Text en © 2011 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
spellingShingle Reviews/Commentaries/ADA Statements
Giugliano, Dario
Maiorino, Maria Ida
Bellastella, Giuseppe
Chiodini, Paolo
Ceriello, Antonio
Esposito, Katherine
Efficacy of Insulin Analogs in Achieving the Hemoglobin A(1c) Target of <7% in Type 2 Diabetes: Meta-analysis of randomized controlled trials
title Efficacy of Insulin Analogs in Achieving the Hemoglobin A(1c) Target of <7% in Type 2 Diabetes: Meta-analysis of randomized controlled trials
title_full Efficacy of Insulin Analogs in Achieving the Hemoglobin A(1c) Target of <7% in Type 2 Diabetes: Meta-analysis of randomized controlled trials
title_fullStr Efficacy of Insulin Analogs in Achieving the Hemoglobin A(1c) Target of <7% in Type 2 Diabetes: Meta-analysis of randomized controlled trials
title_full_unstemmed Efficacy of Insulin Analogs in Achieving the Hemoglobin A(1c) Target of <7% in Type 2 Diabetes: Meta-analysis of randomized controlled trials
title_short Efficacy of Insulin Analogs in Achieving the Hemoglobin A(1c) Target of <7% in Type 2 Diabetes: Meta-analysis of randomized controlled trials
title_sort efficacy of insulin analogs in achieving the hemoglobin a(1c) target of <7% in type 2 diabetes: meta-analysis of randomized controlled trials
topic Reviews/Commentaries/ADA Statements
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024378/
https://www.ncbi.nlm.nih.gov/pubmed/21216850
http://dx.doi.org/10.2337/dc10-1710
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