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Injection: Treats diabetes.

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Multiple HbA1c targets and insulin analogues in type 2 diabetes: a systematic review

The review assessed the role of insulin analogues to reach different optimal glycated haemoglobin (HbA1C) targets in type 2 diabetic patients, concluding that basal-bolus insulin regimens obtained the best results. Given the questionable statistical analyses used and the high levels of variation found across trials, the authors' conclusions should not be considered reliable.

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

Version: 2011

Suggested insulin regimens for patients with type 1 diabetes mellitus who wish to fast during the month of Ramadan

This review evaluated the use of different insulin regimens during Ramadan fasting in adults with type 1 diabetes. The authors’ overall conclusion about the lack of data appeared to be justified, but their suggested changes to insulin regimens may not be reliable given concerns about the review methodology and the quantity and quality of the data.

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

Version: 2008

Increase of body weight during the first year of intensive insulin treatment in type 2 diabetes: systematic review and meta-analysis

The review concluded that body weight increase during first year insulin treatment was associated with intensity of treatment and depended on the insulin regimen applied. The review was generally well conducted but potential for publication and language bias, an evidence base of limited quality and substantial heterogeneity in the analyses mean that the authors’ conclusions may not be reliable.

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

Version: 2011

Comparative effectiveness, safety, and indications of insulin analogues in premixed formulations for adults with type 2 diabetes

This review concluded that premixed insulin analogues provided glycemic control similar to that of premixed human insulin, and may provide tighter glycaemic control than long-acting insulin analogues and non-insulin diabetic agents. This was a generally well-conducted review, however, the conclusions seemed overly strong given the evidence presented, and should be treated with some caution.

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

Version: 2008

Revisiting the efficacy of long-acting insulin analogues on adults with type 1 diabetes using mixed-treatment comparisons

The review concluded that long-acting insulin analogues were similar in terms of efficacy and safety and offered little to no clinical advantage over conventional human insulin in patients with type 1 diabetes. The authors' conclusions should be considered tentative due to limitations in the evidence base and substantial heterogeneity.

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

Version: 2011

Long-acting insulin analogues for diabetes mellitus: meta-analysis of clinical outcomes and assessment of cost-effectiveness

Long-acting insulin analogues (specifically insulin glargine and insulin detemir) were investigated for the treatment of diabetes mellitus. The authors found that long-acting insulin analogue use did not result in clinically important outcomes for all patients with diabetes mellitus. This review was generally well-conducted and the authors' conclusions are likely to be reliable.

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

Version: 2007

A review of human and analogue insulin trials

The author concluded that, for both type 1 and 2 diabetes, the most frequently seen benefits of insulin analogue regimens compared with human insulin are reduced hypoglycaemia and post-prandial glucose levels. The conclusions are consistent with the data presented but, owing to limited reporting of review methodology and the lack of a validity assessment, the reliability of these conclusions cannot be evaluated.

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

Version: 2007

Clinical effectiveness and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes: systematic review and economic evaluation

The authors concluded that observational studies as well as randomised controlled studies showed that continuous subcutaneous insulin infusion provides some advantages over multiple daily injections in adults and children with type I diabetes. Given the small number of varied trials and differences in findings compared with observational studies, the authors’ conclusions should be interpreted with caution.

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

Version: 2010

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

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.

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

Version: 2011

Efficacy and safety of insulin analogues for the management of diabetes mellitus: a meta-analysis

This review concluded that differences between conventional insulins and insulin analogues were minimal for the management of type 1, type 2 and gestational diabetes mellitus. Overall, the authors' conclusions were supported by the evidence presented, but caution is advised given the limitations of the included evidence and, in particular, the poor quality of the included trials.

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

Version: 2009

Comparative efficacy and safety of long-acting insulin analogs in patients with type 2 diabetes failing on oral therapy: systemic [systematic] review and meta-analyses

Initiating long-acting insulin analogues for people with type 2 diabetes failing on oral agents seemed to provide glycaemic control similar to rapid-acting insulin analogues, NPH insulin or glucagon-like peptide-1 analogues and slightly inferior to biphasic insulin analogues with fewer side effects. The reliability of the conclusions is unclear due to limited evidence.

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

Version: 2012

Oral Diabetes Medications for Adults With Type 2 Diabetes: An Update [Internet]

Given the number of medications available for type 2 diabetes mellitus, clinicians and patients need information about their effectiveness and safety to make informed choices. The objective of this review was to summarize the benefits and harms of medications (metformin, second-generation sulfonylureas, thiazolidinediones, meglitinides, dipeptidyl peptidase-4 [DPP-4] inhibitors, and glucagon-like peptide-1 [GLP-1] receptor agonists), as monotherapy and in combination, for the treatment of adults with type 2 diabetes.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: March 2011
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Type 1 Diabetes: Diagnosis and Management of Type 1 Diabetes in Children and Young People

Clinical guidelines have been defined as ‘systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions’. This guideline addresses the diagnosis and management of children and young people with type 1 diabetes. It has been developed with the aim of providing guidance on: initial management at diagnosis (including consideration of admission criteria and initial insulin regimens); continuing care of children and young people with type 1 diabetes; ongoing monitoring of glycaemic control (including the role of home glucose monitoring and the frequency of HbA1c measurement); management of hypoglycaemia (insufficient blood sugar) and hypoglycaemic coma; prevention and management of diabetic ketoacidosis (including the management of intercurrent illness, that is, illness that occurs alongside type 1 diabetes, for example, influenza); peri-operative management of children and young people with type 1 diabetes; and surveillance for complications. The guideline also addresses the special needs of young people (adolescents) and the interface between paediatric and adult services.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: September 2004
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Drug Class Review: Newer Drugs for the Treatment of Diabetes Mellitus: Final Report [Internet]

Diabetes mellitus (diabetes) is a chronic and insidious disease affecting more than 20 million Americans, approximately 7% of the population. Within the last 1 to 2 years, three new antihyperglycemic agents have been approved: pramlintide, exenatide, and sitagliptin. These agents offer mechanisms of glycemic control beyond that of "traditional" oral agents and insulin by targeting alternate gluco-regulatory receptors and hormones such as amylin, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), and dipeptidyl peptidase-4 (DPP-4). The purpose of this review was to compare the effectiveness and harms of newer diabetes medications for persons with diabetes mellitus.

Drug Class Reviews - Oregon Health & Science University.

Version: August 2008
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Saxagliptin (Onglyza): Indicated in Patients with Type 2 Diabetes Mellitus to Improve Glycemic Control in Combination with Metformin and a Sulfonylurea when Dual Therapy with these Two Agents, with Diet and Exercise, does not Provide Adequate Glycemic Control [Internet]

Saxagliptin (Onglyza) is an oral antihyperglycemic agent belonging to the dipeptidyl peptidase-4 (DPP-4) inhibitor class. Saxagliptin is indicated for patients with type 2 diabetes mellitus to improve glycemic control in combination with metformin, a sulfonylurea, metformin and a sulfonylurea, or long- or intermediate-acting insulin (with or without metformin), when these drugs do not provide adequate glycemic control. The recommended dose of saxagliptin is 5 mg once daily for most patients and 2.5 mg once daily for patients with moderate or severe renal impairment (creatinine clearance [CrCl] ≤ 50 mL/min).

Common Drug Review - Canadian Agency for Drugs and Technologies in Health.

Version: November 2013
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Drug Class Review: Thiazolidinediones: Final Report Update 1 [Internet]

There are 2 thiazolidinediones approved for prescription use in the United States, rosiglitazone maleate (Avandia™) and pioglitazone hydrochloride (Actos®). Both drugs are approved by the United States Food and Drug Administration for use in adults for the treatment of type 2 diabetes, either as monotherapy or in combination with insulin, metformin, or sulfonylurea when diet, exercise, and a single agent does not result in adequate glycemic control. Neither drug is currently approved for use in prediabetes or the metabolic syndrome. The objective of this review was to compare thiazolidinediones in the treatment of type 2 diabetes, prediabetes, and the metabolic syndrome.

Drug Class Reviews - Oregon Health & Science University.

Version: August 2008
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Evaluation of the therapeutic benefits and harms of exenatide: Executive summary of final report A05-23, Version 1.0

The aims of the planned review arose from the wording of the commission by the Federal Joint Committee, as well as from the approval status of exenatide for the treatment of patients with type 2 diabetes mellitus. The following questions were to be answered by the rapid report: In patients with type 2 diabetes mellitus receiving blood-glucose lowering treatment with metformin and/or sulfonylurea, is there a benefit of add-on exenatide versus add-on placebo or no add-on treatment? In patients with type 2 diabetes mellitus receiving blood-glucose lowering treatment with metformin and/or sulfonylurea, is there an additional benefit of add-on exenatide versus add-on active control?

Institute for Quality and Efficiency in Health Care: Executive Summaries [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: August 20, 2007

Type 2 Diabetes: Newer Agents for Blood Glucose Control in Type 2 Diabetes

This guideline covers newer agents for blood glucose control in adults with type 2 diabetes; it does not address care for pregnant women with diabetes. It is a partial update of ‘Type 2 diabetes’, NICE clinical guideline 66 (CG 66), published in 2008, which updated NICE clinical guidelines E, F, G and H (2002) and updated and replaced the recommendations on type 2 diabetes in NICE technology appraisal guidance 53 (2002), 60 and 63 (2003).

NICE Clinical Guidelines - National Institute for Health and Clinical Excellence (UK).

Version: May 2009
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Screening for Cystic Fibrosis-Related Diabetes: A Systematic Review

Cystic fibrosis (CF) is an inherited disease that leads to damage to lungs, pancreas and other organs. Most people with CF die prematurely from lung disease, but survival has improved markedly over the decades and it is estimated that children born with CF now will live to an average age of 50 years. CF-related diabetes (CFRD) is due to damage to the pancreas, which, over time, loses its capacity to produce sufficient insulin. CFRD is becoming more common owing to the improved survival of people with CF.

Health Technology Assessment - NIHR Journals Library.

Version: May 2012
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Interventions To Improve Cardiovascular Risk Factors in People With Serious Mental Illness [Internet]

Individuals with serious mental illness (SMI) have excess mortality from cardiovascular disease (CVD) and high rates of CVD risk factors such as diabetes, obesity, and hyperlipidemia. We conducted a systematic review to evaluate interventions to improve CVD risk factors in adults with SMI.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: April 2013
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