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Marra LP, Araújo VE, Silva TB, et al. Clinical Effectiveness and Safety of Analog Glargine in Type 1 Diabetes: A Systematic Review and Meta-Analysis. Diabetes Ther. 2016;7(2):241-58doi: 10.1007/s13300-016-0166-y.
Marra, L. P., Araújo, V. E., Silva, T. B., Diniz, L. M., Guerra Junior, A. A., Acurcio, F. A., Godman, B., & Álvares, J. (2016). Clinical Effectiveness and Safety of Analog Glargine in Type 1 Diabetes: A Systematic Review and Meta-Analysis. Diabetes therapy : research, treatment and education of diabetes and related disorders, 7(2), 241-58. https://doi.org/10.1007/s13300-016-0166-y
Marra, Lays P, et al. "Clinical Effectiveness and Safety of Analog Glargine in Type 1 Diabetes: A Systematic Review and Meta-Analysis." Diabetes therapy : research, treatment and education of diabetes and related disorders vol. 7,2 (2016): 241-58. doi: https://doi.org/10.1007/s13300-016-0166-y
Marra LP, Araújo VE, Silva TB, Diniz LM, Guerra Junior AA, Acurcio FA, Godman B, Álvares J. Clinical Effectiveness and Safety of Analog Glargine in Type 1 Diabetes: A Systematic Review and Meta-Analysis. Diabetes Ther. 2016 Jun;7(2):241-58. doi: 10.1007/s13300-016-0166-y. Epub 2016 Apr 05. PMID: 27048292; PMCID: PMC4900976.
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Diabetes Ther. 2016 Jun;7(2):241-58. doi: 10.1007/s13300-016-0166-y. Epub 2016 Apr 05.

Clinical Effectiveness and Safety of Analog Glargine in Type 1 Diabetes: A Systematic Review and Meta-Analysis.

Diabetes therapy : research, treatment and education of diabetes and related disorders

Lays P Marra, Vania E Araújo, Thales B C Silva, Leonardo M Diniz, Augusto A Guerra Junior, Francisco A Acurcio, Brian Godman, Juliana Álvares

Affiliations

  1. School of Pharmacy, Graduate Program in Medicines and Pharmaceutical Assistance, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil. [email protected].
  2. School of Pharmacy, Graduate Program in Medicines and Pharmaceutical Assistance, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
  3. School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
  4. Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.
  5. Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
  6. Liverpool Health Economics Centre, University of Liverpool Management School, Liverpool, UK.

PMID: 27048292 PMCID: PMC4900976 DOI: 10.1007/s13300-016-0166-y

Abstract

INTRODUCTION: The use of insulin analogs for the treatment of type 1 diabetes mellitus (T1DM) is widespread; however, the therapeutic benefits still require further evaluation given their higher costs. The objective of this study was to evaluate the effectiveness and safety of analog insulin glargine compared to recombinant DNA (rDNA) insulin in patients with T1DM in observational studies, building on previous reviews of randomized controlled trials comparing neutral protamine Hagedorn insulin and insulin glargine.

METHODS: A systematic review with a meta-analysis was performed. The review included cohort studies and registries available on PubMed, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as manual and gray literature searches. The meta-analysis was conducted in Review Manager 5.3 software. The primary outcomes were glycated hemoglobin (Hb1Ac), weight gain, and hypoglycemia. Methodological quality was assessed using the Newcastle-Ottawa scale.

RESULTS: Out of 796 publications, 11 studies were finally included. The meta-analysis favored insulin glargine in HbA1c outcomes (adult patients) and hypoglycemic episodes (P < 0.05), but without reaching glycemic control (Hb1Ac to approximately 7%). The methodological quality of the studies was moderate, noting that 45% of studies were funded by pharmaceutical companies.

CONCLUSION: Given the high heterogeneity of the studies, the discrete value presented by the estimated effect on effectiveness and safety, potential conflicts of interest of the studies, and the appreciable higher cost of insulin glargine, there is still no support for recommending first-line therapy with analogs. The role of analogs in the treatment of T1DM could be better determined by further observational studies of good methodological quality to assess their long-term effectiveness and safety, as well as their cost-effectiveness.

Keywords: Comparative effectiveness research; Glargine; Insulin; Meta-analysis; Systematic review; Type 1 diabetes mellitus

References

  1. Diabetes Res Clin Pract. 2005 Oct;70(1):1-7 - PubMed
  2. Diabetes Care. 2007 Jan;30 Suppl 1:S4-S41 - PubMed
  3. N Engl J Med. 1993 Aug 19;329(8):573-6 - PubMed
  4. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD006297 - PubMed
  5. JAMA. 2003 Jan 22-29;289(4):454-65 - PubMed
  6. Diabetes Care. 2000 May;23(5):644-9 - PubMed
  7. Curr Med Res Opin. 2007 Dec;23(12):3131-6 - PubMed
  8. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD003287 - PubMed
  9. Health Policy. 2012 Aug;106(3):225-32 - PubMed
  10. Am J Psychiatry. 2006 Feb;163(2):185-94 - PubMed
  11. Diabetes Technol Ther. 2004 Oct;6(5):589-95 - PubMed
  12. Pharmacoepidemiol Drug Saf. 2013 Dec;22(12):1326-35 - PubMed
  13. BMJ. 2013 Feb 06;346:f755 - PubMed
  14. Diabetes. 2000 Dec;49(12):2142-8 - PubMed
  15. Appl Health Econ Health Policy. 2014 Feb;12(1):19-32 - PubMed
  16. Intern Med. 2007;46(13):937-43 - PubMed
  17. JAMA. 2000 Apr 19;283(15):2008-12 - PubMed
  18. Pediatr Diabetes. 2005 Sep;6(3):150-4 - PubMed
  19. Vasc Health Risk Manag. 2009;5(1):121-8 - PubMed
  20. Diabetes Care. 2002 Feb;25(2):275-8 - PubMed
  21. J Pediatr Endocrinol Metab. 2007 Apr;20(4):517-25 - PubMed
  22. BMJ. 2012 Jan 03;344:d7292 - PubMed
  23. Diabetes Technol Ther. 2003;5(5):801-6 - PubMed
  24. Front Pharmacol. 2013 May 14;4:39 - PubMed
  25. Clin Ther. 2003 Jun;25(6):1541-77, discussion 1539-40 - PubMed
  26. Clin Chem. 2003 Aug;49(8):1245-7 - PubMed
  27. Health Technol Assess. 2004 Nov;8(45):iii, 1-57 - PubMed
  28. Pediatr Diabetes. 2008 Jun;9(3 Pt 2):83-90 - PubMed
  29. Pol Arch Med Wewn. 2011 Jul-Aug;121(7-8):237-46 - PubMed
  30. Pediatr Diabetes. 2011 Aug;12(5):501-5 - PubMed

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