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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews.

Treatment regimens with insulin analogues and haemoglobin A1c target of <7% in type 2 diabetes: a systematic review

Review published: 2011.

Bibliographic details: Giugliano D, Maiorino MI, Bellastella G, Chiodini P, Esposito K.  Treatment regimens with insulin analogues and haemoglobin A1c target of <7% in type 2 diabetes: a systematic review. Diabetes Research and Clinical Practice 2011; 92(1): 1-10. [PubMed: 20822821]

Quality assessment

This review found that glycated haemoglobin targets of less than 7% could be achieved with the use of insulin analogues depending on the insulin regimen used. The authors' conclusions should be interpreted with caution due to the poor quality of the trials and the indirect comparisons made in the review analyses. Full critical summary

Abstract

We conducted a systematic review of randomized controlled trials that evaluated the effectiveness of insulin regimens (basal, biphasic, prandial, and basal-bolus) with insulin analogues to reach the haemoglobin A1c target of <7% in patients with type 2 diabetes. We identified 48 trials, with 85 arms and 30,588 patients. There were 38 arms using basal insulin, with 17,588 patients, and a primary outcome of 41.4% (95% CI=35.6-47.4%); 26 arms using biphasic insulin, with 9237 patients, and a primary outcome of 46.5% (40.8-52.3%); 9 arms using prandial insulin, with 1605 patients, and a primary outcome of 39.6% (95% CI, 28.6-51.3%); and 12 arms using basal-bolus insulin, with 2114 patients, and a primary outcome of 53.9% (43.5-64). The high heterogeneity was related, in part, to first time insulin use, final insulin dose, and use of oral drug. The overall incidence of hypoglycaemia ranged from 0 to 4.71 events/patient/30 days; weight gain ranged from 1.75 kg for basal to 3 kg for biphasic insulin. The HbA1c target of <7% can be achieved in a percentage of type 2 diabetic patients ranging from 40% to 54% depending on the particular insulin regimen.

Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2013 University of York.

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