E Mannucci1, M Monami, N Marchionni. 1. Department of Cardiovascular Medicine, Section of Geriatric Cardiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. edoardo.mannucci@unifi.it
Abstract
AIM: Short-acting insulin analogues, in comparison with regular human insulin (HRI), provide a greater control of postprandial glucose, while their superiority on haemoglobin A1c (HbA1c) is controversial. METHOD: All randomized controlled trials (RCTs) with a duration >4 weeks comparing short-acting insulin analogues (lispro, aspart or glulisine) with HRI in type 2 diabetic patients were retrieved; data on HbA1c and postprandial glucose et end-point and incidence of severe hypoglycaemia were extracted and meta-analysed. RESULTS: A total of 13 RCTs (7, 4 and 2 with lispro, aspart and glulisine, respectively) were retrieved and included in the analysis. Short-acting analogues reduced HbA1c by 0.4% (0.1-0.6%) (p = 0.027) in comparison with HRI. A significant improvement was observed also in self-monitored 2 h postbreakfast and dinner blood glucose. The overall rate of severe hypoglycaemia was not significantly different with short-acting analogues and HRI [Mantel-Haenszel odds ratio for 95% confidence interval 0.61 (0.25-1.45)]. CONCLUSION: In type 2 diabetic patients, short-acting insulin analogues provide a better control of HbA1c and postprandial glucose than regular human insulin, without any significant reduction of the risk of severe hypoglycaemia.
AIM: Short-acting insulin analogues, in comparison with regular humaninsulin (HRI), provide a greater control of postprandial glucose, while their superiority on haemoglobin A1c (HbA1c) is controversial. METHOD: All randomized controlled trials (RCTs) with a duration >4 weeks comparing short-acting insulin analogues (lispro, aspart or glulisine) with HRI in type 2 diabeticpatients were retrieved; data on HbA1c and postprandial glucose et end-point and incidence of severe hypoglycaemia were extracted and meta-analysed. RESULTS: A total of 13 RCTs (7, 4 and 2 with lispro, aspart and glulisine, respectively) were retrieved and included in the analysis. Short-acting analogues reduced HbA1c by 0.4% (0.1-0.6%) (p = 0.027) in comparison with HRI. A significant improvement was observed also in self-monitored 2 h postbreakfast and dinner blood glucose. The overall rate of severe hypoglycaemia was not significantly different with short-acting analogues and HRI [Mantel-Haenszel odds ratio for 95% confidence interval 0.61 (0.25-1.45)]. CONCLUSION: In type 2 diabeticpatients, short-acting insulin analogues provide a better control of HbA1c and postprandial glucose than regular humaninsulin, without any significant reduction of the risk of severe hypoglycaemia.
Authors: Kees J Gorter; Floris Alexander van de Laar; Paul G H Janssen; Sebastian T Houweling; Guy E H M Rutten Journal: BMJ Clin Evid Date: 2012-10-11
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Authors: Simona Cammarota; Lucio Marcello Falconio; Dario Bruzzese; Alberico Luigi Catapano; Manuela Casula; Anna Citarella; Luigi De Luca; Maria Elena Flacco; Lamberto Manzoli; Maria Masulli; Enrica Menditto; Andrea Mezzetti; Salvatore Riegler; Ettore Novellino; Gabriele Riccardi Journal: PLoS One Date: 2013-11-07 Impact factor: 3.240