Effectiveness and safety of insulin glargine versus detemir analysis in patients with type 1 diabetes : systematic review and meta-analysis

Silva, Thales B. C. and Almeida, Paulo H. R. F. and Araújo, Vania E. and de Assis Acurcio, Francisco and Guerra Júnior, Augusto A. and Godman, Brian and Alvares, Juliana (2018) Effectiveness and safety of insulin glargine versus detemir analysis in patients with type 1 diabetes : systematic review and meta-analysis. Therapeutic Advances in Endocrinology and Metabolism, 9 (8). pp. 241-254. ISSN 2042-0196

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    INTRODUCTION: Diabetes mellitus type 1 (DM1) is an autoimmune disease characterized by metabolic destruction of pancreatic cells responsible for insulin production, with treatment based on replacing insulin. Long-acting insulin analogs are indicated for patients with DM1 who exhibit important oscillations of their daily glycemia despite their higher costs. OBJECTIVE: To evaluate the effectiveness and safety of two long acting insulins. insulin glargine and detemir in treating patients with DM1. METHODS: Systematic review with meta-analysis of observational studies (cohort and registry), available in the database, gray literature and complementary search in Diabetes Care Journal. Outcomes assessed were: glycated hemoglobin concentration, fasting plasma glucose or capillary, occurrence of episodes of severe hypoglycemia and occurrence of nocturnal hypoglycemia. The assessment of methodological quality was performed using the Newcastle score. The meta-analyses were performed on software Review Manager ® 5.2. RESULTS: Out of 705 publications, 8 cohort studies were included. The quality of these studies was classified as high. In the meta-analysis results regarding episodes of severe hypoglycemia (p = 0.02) and fasting glucose (p = 0.01) were in favour of detemir. The glycated hemoglobin (p = 0.49; I2= 89) showed high heterogeneity and no statistically significant difference between the two. The meta-analysis of total insulin dose favored glargine (p = 0.006; I2= 75). The rates of nocturnal hypoglycemia (NH) were evaluated only for one study and showed a significant reduction of NH after therapy with detemir, (p < 0.0001). CONCLUSION: Although some outcomes were favourable to determir insulin analogue, it has not been possible to identify important differences of effectiveness and safety between the two analogs. These results can help in the current debate on the inclusion of long-acting analogs on the list of reimbursed medicines in the Brazil especially with the recent introduction of insulin glargine biosimilar at considerably lower prices.