Comparative efficiency and safety of insulin degludec/aspart with insulin glargine in type 2 diabetes: a meta-analysis of randomized controlled trials

Abstract

Recent studies have found compared with insulin glargine (IGlar), insulin degludec/aspart (IDeg/Asp) may provide adequate glycemic control and prevent hypoglycemia events in type 2 diabetes mellitus (T2DM). Consequently, we performed a meta-analysis to appraise and compare the efficiency and safety of IDeg/Asp and IGlar in the treatment of T2DM. We sought the databases including PubMed, Embase, Scopus, Cochrane library to confirm related articles which inspected the effect of IDeg/Asp versus IGlar for the treatment of T2DM until May 2021. Finally, six randomized controlled trials (RCTs) of 1,346 patients were included. The results showed that IDeg/Asp significantly decreased the mean hemoglobin A1c (HbA1c) level but was prone to serious adverse events, and IGlar increased the nocturnal confirmed hypoglycemia events. Besides, there were no significant changes in other indicators, including mean fasting plasma glucose (FPG) level, nine-point self-measured plasma glucose (SMPG) level, and adverse events. What's more, we found that there was no significant difference in the occurrence of hypoglycemia overall, but our subgroup analysis of confirmed hypoglycemia revealed the population in this subgroup (duration of diabetes ≤11 years) might has its particularity effecting the hypoglycemia outcome. Concerning efficiency, IDeg/Asp may have advantages in controlling the mean HbA1c level. Regarding safety, IGlar might increase the risk of nocturnal confirmed hypoglycemia. Further evidence is needed to compare better the efficiency and safety of IDeg/Asp versus IGlar therapy.

Initiating or Switching to Insulin Degludec/Insulin Aspart in Adults with Type 2 Diabetes in Malaysia: Results from a Prospective, Non-Interventional Real-World Study

“…In the meta-analysis of studies comparing IDegAsp and IGlar, the rates of confirmed overall hypoglycemia (odds ratio [OR] = 1.59; 95% CI: 0.97 to 2.61; p=0.07; I 2 =66%) and nocturnal hypoglycemia (OR=0.54, 95% CI 0.31 to 0.94, p=0.49; I 2 =57%) were not significantly different between the treatment groups. 18 Similarly, the risk of confirmed hypoglycemia with IDegAsp, premixed insulin BID (OR 0.52; 95% CI: 0.42 to 0.65; I 2 =23.9%) and basal insulin OD (OR 0.51, 95% CI 0.27 to 0.95, I 2 =66.0) was comparable. In a meta-analysis, nocturnal hypoglycemia was significantly reduced with IDegAsp.…”

“…17 In another metaanalysis of six RCTs including 1346 patients with T2DM, a significant decrease in mean HbA1c was reported with IDegAsp OD compared with insulin glargine (IGlar) OD. 18 In another retrospective observational study, IDegAsp OD led to significantly lower HbA1c levels and FPG than basal insulin in 87 patients with T2DM in each treatment group. 19 The reduction in FPG with IDegAsp could be attributed to the long-acting effect of the IDeg analog while HbA1c reduction may be due to the prandial coverage of the IAsp analog.…”