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

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.