Long-acting insulin ‘probably superior’ to intermediate-acting insulin

Several insulin formulations are available to treat hyperglycaemia in patients with type 1 diabetes. Andrea Tricco from St Michael’s Hospital, Toronto, and colleagues compared the relative effectiveness, safety and cost-effectiveness of long-acting insulin analogues (such as insulin glargine and insulin detemir) and intermediate-acting insulins (such as NPH insulin and insulin lente).

The meta-analysis of 39 studies suggests that long-acting insulin is “probably superior” owing to the greater reduction in haemoglobin A1c, less weight gain and lower incidence of severe hypoglycaemia compared with intermediate-acting insulin. Some, but not all, studies also found that long-acting insulin was more cost-effective than intermediate-acting insulin.

The choice of insulin should be tailored according to “preference, cost and accessibility”, say the researchers, writing in The BMJ (online, 1 October 2014)^[1].