The impact of insulin type on severe hypoglycaemia events requiring inpatient and emergency department care in patients with type 2 diabetes

Solomon, Matthew D.; Vijan, Sandeep; Forma, Felicia; Conrad, Ryan M.; Summers, N.; Lakdawalla, Darius N.

doi:10.1016/j.diabres.2013.09.013

Cited by 10 publications

(15 citation statements)

References 35 publications

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“…We found a pooled RR for severe hypoglycaemia of 0.80 (95% CI 0.51‐1.3; I 2 = 0%) . Six of eight observational studies (N = 178 252) found no significant difference in the incidence of severe hypoglycaemia, although the studies reported the frequency in varying ways that could not be pooled . For nocturnal hypoglycaemia, we found a pooled RR of 0.97 (95% CI 0.86‐1.1; I 2 = 22.6%).…”

Section: Resultsmentioning

confidence: 77%

“…[42][43][44][45][46][47][48] Six of eight observational studies (N = 178 252) found no significant difference in the incidence of severe hypoglycaemia, although the studies reported the frequency in varying ways that could not be pooled. 40,[53][54][55][56]58 For nocturnal hypoglycaemia, we found a pooled RR of 0.97 (95% CI 0.86-1.1; I 2 = 22.6%). Body weight gain was less with detemir than glargine (1.2 kg vs. 2.1 kg across six studies, ETD -1.2, 95% CI −1.5 to −0.78; I 2 = 40.2%, see Appendix S1, Appendix F, Figure F-8).…”

Section: Detemir Versus Glarginementioning

confidence: 76%

“…The total number of patients in the remaining fair‐quality trials was 2762, with 12‐52 weeks of treatment. We included 12 observational studies (eight with hypoglycaemia outcomes and four with cancer outcomes), of which one was poor quality …”

Section: Resultsmentioning

confidence: 99%

“…[49][50][51] The total number of patients in the remaining fairquality trials was 2762, with 12-52 weeks of treatment. We included 12 observational studies (eight with hypoglycaemia outcomes 40,[52][53][54][55][56][57][58] and four with cancer outcomes [59][60][61][62] ), of which one was poor quality. 52 There was low-strength evidence of no significant difference in glycaemic control between detemir and glargine based on seven trials.…”

Section: Detemir Versus Glarginementioning

confidence: 99%

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Comparative effectiveness and harms of long‐acting insulins for type 1 and type 2 diabetes: A systematic review and meta‐analysis

Holmes

Crabtree

McDonagh

2019

Diabetes Obesity Metabolism

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Aim: To review evidence comparing benefits and harms of long-acting insulins in patients with type 1 and 2 diabetes.Methods: MEDLINE and two Cochrane databases were searched during February 2018. Two authors selected studies meeting inclusion criteria and assessed their quality. Comparative studies of adult or paediatric patients with diabetes treated with insulin degludec, detemir or glargine were included. Meta-analysis was used to combine results of similar studies, and the I 2 statistic calculated to assess statistical heterogeneity.Results: Of 2534 citations reviewed, 70 studies met the inclusion criteria. No statistically significant differences in HbA1c were seen between any two insulins or formulations. Hypoglycaemia was less probable with degludec than with glargine, including nocturnal hypoglycaemia in type 1 (rate ratio 0.68, 95% CI 0.56-0.81) and type 2 diabetes (rate ratio 0.73, 95% CI 0.65-0.82), and severe hypoglycaemia in type 2 diabetes (relative risk 0.72, 95% CI 0.54-0.96). Patients with type 2 diabetes had higher rates of withdrawal because of adverse events when treated with detemir compared with glargine (relative risk 2.1, 95% CI 1.4-3.3). Adults taking detemir gained about 1 kg less body weight than those taking degludec (type 1) or glargine (type 2).Conclusions: No differences in glycaemic control were seen between insulin degludec, detemir and glargine. Hypoglycaemia was less probable with degludec than glargine, and patients taking detemir gained less body weight than those given degludec or glargine. In type 2 diabetes, withdrawals as a result of adverse events were more probable with detemir than glargine. K E Y W O R D Sbasal insulin, glycaemic control, hypoglycaemia, systematic review, type 1 diabetes, type 2 diabetes

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Section: Resultsmentioning

confidence: 77%

Section: Detemir Versus Glarginementioning

confidence: 76%

Section: Resultsmentioning

confidence: 99%

Section: Detemir Versus Glarginementioning

confidence: 99%

See 2 more Smart Citations

Comparative effectiveness and harms of long‐acting insulins for type 1 and type 2 diabetes: A systematic review and meta‐analysis

Holmes

Crabtree

McDonagh

2019

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

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“…17 Among nonpregnant adults, clinical trials comparing efficacy outcomes with basal insulin analogs found that insulin analogs are mostly noninferior or better than other insulins and reduce the incidence of hypoglycemia and weight gaintwo main adverse effects that are of concern for the patient and the physician. [18][19][20][21] Switching patients with T2DM, who were inadequately controlled on NPH, to basal analog was associated with an improvement of glycemic control and reduction of hypoglycemic events. 22 The first use of basal analog in pregnancy was in patients with type 1 diabetes mellitus (T1DM), with two randomized controlled studies comparing detemir and NPH.…”

Section: Discussionmentioning

confidence: 99%

Basal Insulin Analogs versus Neutral Protamine Hagedorn for Type 2 Diabetics

Bartal¹,

Ward²,

Refuerzo³

et al. 2019

Am J Perinatol

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Objective To determine whether basal insulin analogs reduce the rate of composite neonatal morbidity compared with neutral protamine Hagedorn (NPH) in women with type 2 diabetes mellitus (T2DM). Study Design This was a retrospective cohort study of women with T2DM and singleton pregnancy at a single tertiary center. Primary outcome was a composite neonatal morbidity of any of the following: shoulder dystocia, large for gestational age, neonatal intensive care unit admission, neonatal hypoglycemia, or respiratory distress syndrome. Secondary outcomes were rates of maternal hypoglycemic events, hypertensive disorders, preterm birth, and primary cesarean delivery. Adjusted relative risk (aRR) and 95% confidence intervals (CI) were calculated. Results Of 233 women with T2DM that met the inclusion criteria, 114 (49%) were treated with basal insulin analogs and 119 (51%) with NPH. The rate of composite neonatal morbidity was similar between groups (73 vs. 60%; aRR: 1.18; 95% CI: 0.92–1.51). There were no differences in the rates of maternal adverse outcomes between the groups. Basal insulin analog was associated with a lower rate of primary cesarean delivery as compared with NPH (21 vs. 36%; aRR: 0.44; 95% CI: 0.25–0.78). Conclusion Among pregnant women with T2DM managed with either basal or NPH insulin regimen, the rates of composite neonatal morbidity and maternal complications were similar.

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Hypoglycemia Among Patients with Type 2 Diabetes: Epidemiology, Risk Factors, and Prevention Strategies

et al. 2018

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Reported rates of hypoglycemia in type 2 diabetes vary widely as there is marked heterogeneity in how hypoglycemia is defined, measured, and reported. In randomized controlled trials, rates of severe hypoglycemia ranged from 0.7 to 12 per 100 person-years. In observational studies, hospitalizations or emergency department visits for hypoglycemia were experienced by 0.2 (patients treated without insulin or sulfonylurea) to 2.0 (insulin or sulfonylurea users) per 100 person-years. Patient-reported hypoglycemia is much more common. Over the course of 6 months, 1-4% non-insulin users reported need for medical attention for hypoglycemia; 1-17%, need for any assistance; and 46-58%, any hypoglycemia symptoms. Similarly, over a 12-month period, 4-17% of insulin-treated patients reported needing assistance and 37-64% experienced any hypoglycemic symptoms. Hypoglycemia is most common among older patients with multiple or advanced comorbidities, patients with long diabetes duration, or patients with a prior history of hypoglycemia. Insulin and sulfonylurea use, food insecurity, and fasting also increase hypoglycemia risk. Clinical decision support tools may help identify at-risk patients. Prospective trials of efforts to reduce hypoglycemia risk are needed, and there is emerging evidence supporting multidisciplinary interventions including treatment de-intensification, use of diabetes technologies, diabetes self-management, and social support. Hypoglycemia among patients with type 2 diabetes is common. Patient-centered multidisciplinary care may help proactively identify at-risk patients and address the multiplicity of factors contributing to hypoglycemia occurrence.

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The impact of insulin type on severe hypoglycaemia events requiring inpatient and emergency department care in patients with type 2 diabetes

Cited by 10 publications

References 35 publications

Comparative effectiveness and harms of long‐acting insulins for type 1 and type 2 diabetes: A systematic review and meta‐analysis

Comparative effectiveness and harms of long‐acting insulins for type 1 and type 2 diabetes: A systematic review and meta‐analysis

Basal Insulin Analogs versus Neutral Protamine Hagedorn for Type 2 Diabetics

Hypoglycemia Among Patients with Type 2 Diabetes: Epidemiology, Risk Factors, and Prevention Strategies

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