Table 11.4Insulin glargine vs NPH insulin

Meta-analysis195 Bedtime insulin glargine vs NPH once or twice daily
N=3,151
Duration:
6–12 months
Meta-analysis194 Bedtime insulin glargine vs NPH once or twice daily
N=2,304
Duration:
24–28 weeks
RCT196 Bedtime insulin glargine vs bedtime NPH
N=110
Duration:
36 weeks
RCT200 Insulin glargine once daily vs once daily NPH
N=204
Duration:
4 weeks
RCT199 Bedtime insulin glargine vs bedtime NPH
N=481
Duration:
24 weeks
RCT206 Bedtime insulin glargine vs bedtime NPH
N=443
Duration:
24 weeks
Proportion achieving 7% HbA1c targetNSNS (7.5% target)NS (7.5% target)
Mean HbA1c at endpointWMD of change of HbA1c from baseline to study endpoint:
NS
NSNSNSNSChange in mean HbA1c at endpoint greater in glargine group (−0.99% vs −0.77%, p=0.003)
FPG8±0.1 vs 9±0.0 mmol/l (p=0.02) at endpoint5.75±0.02 vs 5.96±0.03 mmol/l (p<0.001) (mean values in last 12 weeks of the study)NSNS (FBG)NS
Insulin doseNSNSNSNS
Body weightNSNSNS
Hypoglycaemia:
overall rates
Symptomatic and overall hypoglycaemia. RR 0.84 (0.75, 0.95) p=0.005 in favour of glargine11% risk reduction with insulin glargine in documented symptomatic hypoglycaemia (p=0.0006).
46% risk reduction with insulin glargine in documented severe hypoglycaemia (p=0.04)
4.1±0.8 vs 9.0±2.3 episodes/patient year (p<0.05) of symptomatic but not confirmed hypoglycaemia during the first 12 weeks. NS thereafterNS27% risk reduction with insulin glargine in documented symptomatic hypoglycaemia (p=0.042)Number of hypoglycaemic episodes lower in glargine group (682 vs 1019; p<0.004)
NocturnalSymptomatic nocturnal hypoglycaemia. RR 0.66 (0.55, 0.80) p<0.0001 in favour of glargine26% risk reduction in nocturnal hypoglycaemia (p<0.0001). 59% risk reduction in severe nocturnal hypoglycaemia (p<0.02)7.3% vs 19.1%; (p=0.0123) of patients experienced symptomatic nocturnal hypoglycaemia22% risk reduction with insulin glargine compared to NPH insulin (p<0.001) and this was 19% for confirmed nocturnal events (p<0.01)Number of hypoglycaemic episodes lower in glargine group (221 vs 620; p<0.001)
DaytimeNSNS
AEsNS (no meta-analysis)NSNSNSNSNS

From: 11, Glucose control: insulin therapy

Cover of Type 2 Diabetes
Type 2 Diabetes: National Clinical Guideline for Management in Primary and Secondary Care (Update).
NICE Clinical Guidelines, No. 66.
National Collaborating Centre for Chronic Conditions (UK).
Copyright © 2008, Royal College of Physicians of London.

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