Long Acting Insulin without Significant Benefit Over Standard NPH Insulin
Long acting insulins, such as insulin glargine (Lantus) and insulin detemir (Levemir) are similar to human insulin but engineered to have longer half-lives. In clinical trials, long acting insulin analogs demonstrated a decreased risk of hypoglycemia, however recent evidence suggests no clinical advantage over standard NPH insulin despite much higher costs. Lipska and colleagues retrospectively evaluated 25, 489 patients with type 2 diabetes starting insulin therapy. They identified 39 hypoglycemia-related emergency room visits or hospital admissions for the 1928 patients who were started with insulin analogs compared with 354 hypoglycemia-related visits or admissions for the 23, 561 patients who were started with NPH insulin. The adjusted hazard ratio was 1.16 (95% CI, 0.71 to 1.78) for hypoglycemia-related ED visits or hospital admissions associated with insulin analog use, suggesting no benefit of the insulin analogs over NPH insulin in reducing hypoglycemia. There were no differences in efficacy, as measured by hemoglobin A1c level between the groups either.
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Lipska KJ, Parker MM, Moffet HH, Huang ES, Karter AJ. Association of Initiation of Basal Insulin Analogs vs Neutral Protamine Hagedorn Insulin With Hypoglycemia-Related Emergency Department Visits or Hospital Admissions and With Glycemic Control in Patients With Type 2 Diabetes. JAMA. 2018 Jun 23.