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The beneficial effect of insulin degludec on nocturnal hypoglycaemia and insulin dose in type 1 diabetic patients: a systematic review and meta-analysis of randomised trials

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Abstract

Aims

Insulin degludec is a new-generation ultra-long-acting basal insulin which offers a significantly more predictable glucose-lowering effect than other long-acting insulin analogues. The aim of this study was to compare the effect of treatment with insulin degludec and long-acting insulin analogues glargine and detemir in type 1 diabetic (T1D) patients by means of a systematic review and meta-analysis.

Methods

The following electronic databases were searched up to January 2014: MEDLINE, EMBASE and The Cochrane Library. Additional references were obtained from the reviewed articles. There were included randomised controlled trials of at least 12-week duration with basal–bolus regimen therapies in T1D patients.

Results

Current analysis included four studies involving 1,846 T1D patients. The combined data from all trials showed a statistically significant reduction in the basal insulin dose (MD −0.042, 95 % CI −0.067 to −0.018, p = 0.001) and the total daily insulin dose (MD −0.072, 95 % CI 0.016 to −0.027, p = 0.002) in the degludec group compared to other long-acting analogues. There was also a significant reduction of nocturnal hypoglycaemia in the degludec group compared to the controls (rate ratio 0.697, 95 % CI 0.617–0.786, p = 0.000). There were no differences between the groups in terms of glycated haemoglobin values, fasting plasma glucose (FPG) and adverse events.

Conclusions

Basal–bolus treatment with insulin degludec was superior to long-acting insulin analogues detemir and glargine in reducing the rate of nocturnal hypoglycaemia. In comparison with other long-acting analogues, treatment with insulin degludec was safe and patients obtained similar metabolic control expressed by HbA1c and FPG levels with the added benefit of a reduced basal and total insulin dose.

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Abbreviations

T1D:

Type 1 diabetes mellitus

IDF:

International Diabetes Federation

ISPAD:

International Society for Pediatric and Adolescent Diabetes

RCT:

Randomised control trial

T2D:

Type 2 diabetes

DM:

Diabetes mellitus

FPG:

Fasting plasma glucose

HbA1c:

Glycated haemoglobin

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

MD:

Mean difference

CI:

Confidence interval

AEs:

Adverse effects

SAEs:

Serious adverse effects

ITT:

Intention-to-treat

SD:

Standard deviation

IDeg:

Insulin degludec

IGlar:

Insulin glargine

IDet:

Insulin detemir

IDegAsp:

Insulin degludec/insulin aspart

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Acknowledgments

Sanofi Aventis and NovoNordisk sponsored lectures as well as participation in medical conferences of AS and KD.

Conflict of interest

There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Statement of human and animal rights

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Paediatrics, Medical University of Warsaw, Dzialdowska 1, 01-184, Warsaw, Poland

    K. Dżygało, A. Kowalska & A. Szypowska

  2. Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland

    D. Golicki

Authors
  1. K. Dżygało
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  2. D. Golicki
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  3. A. Kowalska
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  4. A. Szypowska
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Corresponding author

Correspondence to A. Szypowska.

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Dżygało, K., Golicki, D., Kowalska, A. et al. The beneficial effect of insulin degludec on nocturnal hypoglycaemia and insulin dose in type 1 diabetic patients: a systematic review and meta-analysis of randomised trials. Acta Diabetol 52, 231–238 (2015). https://doi.org/10.1007/s00592-014-0604-0

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