Standard Long-Acting Insulin as Good as Newer Medications
Standard Long-Acting Insulin as Good as Newer Medications
May 2007 - An older type of long-acting insulin is as effective in
treating type 2 diabetes as newer and more expensive kinds, according to
the results of a recent systematic review. However, the newer
medications may cause fewer problems with low blood glucose while
patients are sleeping.
People with type 2 diabetes who need insulin take once-a-day insulin for
longer-lasting or "basal" control. (The review did not cover
shorter-acting insulins used to control the blood glucose spike that
comes from eating.)
Doctors consider the older medication, NPH, to be the current gold
standard for basal insulin. Newer drugs, insulin analogues such as
insulin glargine (trade name Lantus) and insulin detemir (Levemir), have
been marketed as an improvement over NPH.
However, the reviewers found that Lantus and Levemir were almost
identical to NPH in lowering levels of hemoglobin A1c, a widely used
measure of long-term blood glucose control.
The eight studies analyzed had enrolled 2,293 people and were published
in major medical journals. The studies lasted between 24 and 52 weeks.
The review appears in the current issue of The Cochrane Library, a
publication of The Cochrane Collaboration, an international organization
that evaluates research in all aspects of health care. Systematic
reviews draw evidence-based conclusions about medical practice after
considering both the content and quality of existing trials on a topic.
The reviewers said their study indicated "only a minor clinical benefit"
came from using the newer drugs for those with type 2 diabetes when they
looked at overnight low blood glucose. They suggested a "cautious
approach" when using Lantus or Levemir, at least until longer studies of
the effectiveness and safety of the newer medications are completed.
Although NPH is less expensive than the other drugs, the reviewers could
not come to any conclusion on cost-effectiveness or the effect of any of
the drugs on quality of life. The relative impact on long-term
complications such as blindness or kidney failure also was not clear.
"For the patient the good news is that the older medication works very
well," said John Buse, M.D., president-elect of the American Diabetes
Association. "In most people it will lower blood sugar with little risk
of hypoglycemia. The review also shows that Lantus and Levemir had fewer
problems with low blood sugar at night, giving greater security for
those who experience this while sleeping."
Weight gain when starting insulin treatment is a concern because it can
cause some to quit taking the medications if they feel they are getting fat.
"Levemir has been shown to cause less weight gain than NPH in several
studies," said Buse, who was not involved with the Cochrane review. Two
review studies did find that patients treated with the newer drug gained
up to 3.5 pounds less than those on NPH.
Horvath K, et al. Long-acting insulin analogues versus NPH insulin
(human isophane insulin) for type 2 diabetes mellitus (Review). The
Cochrane Database of Systematic Reviews 2007, Issue 2.