Evidence map›Paper›PMID 25274009›Full record

SynthesisBMJ (Clinical research ed.)2014

Safety, effectiveness, and cost effectiveness of long acting versus intermediate acting insulin for patients with type 1 diabetes: systematic review and network meta-analysis.

Andrea C Tricco, Huda M Ashoor, Jesmin Antony, Joseph Beyene, Areti Angeliki Veroniki, Wanrudee Isaranuwatchai, Alana Harrington, Charlotte Wilson, Sophia Tsouros, Charlene Soobiah and 7 more

Registry-linked trialOpen access · hybridAbstract readComparative StudySystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05709938 (Comparison of Insulin Glargine Mixed With Regular Insulin Versus the Standard Neutral Protamine Hagedorn), which is not on this map. Cited by 47 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
47citing papers in PubMed, 9 pooled it
7.7field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05709938 phase4completednot on this mapstarted 2019, after this paper: background citation

Comparison of Insulin Glargine Mixed With Regular Insulin Versus the Standard Neutral Protamine Hagedorn (NPH) and Regular Insulin in the Treatment of Type 1 Diabetes Mellitus

TypeinterventionalSponsorKing Edward Medical UniversityRan2019 to 2021Enrolled68ConditionsTo Assess the Glycemic Control of Insulin Glargine in Combination With Regular Insulin in Type 1 Diabetes in ChildrenArmsGlargine and regular insulin versus NPH and regular insulin
3 · Its place in the literature

Who cites it

47 citing papers in PubMed, 9 syntheses or guidelines pooled it, 116 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2022
    Guideline
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Trial
  11. Trial
  12. Review
  13. Review
  14. Article
  15. Article
  16. Review
  17. Advances in Nanomedicine for Precision Insulin Delivery.Pharmaceuticals (Basel, Switzerland) · 2024
    Review
  18. Article
  19. Review
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors at 6 institutions in 1 country.

Andrea C TriccoLi Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada.
Huda M AshoorLi Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada.
Jesmin AntonyLi Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada.
Joseph BeyeneClinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, L8S 4K1, Canada.
Areti Angeliki VeronikiLi Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada.
Wanrudee IsaranuwatchaiLi Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada.
Alana HarringtonLi Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada.
Charlotte WilsonLi Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada.
Sophia TsourosLi Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada.
Charlene SoobiahLi Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada.
Catherine H YuLi Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada.
Brian HuttonClinical Epidemiology Program, Ottawa Hospital Research Institute and Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8L6, Canada.
Jeffrey S HochLi Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada.
Brenda R HemmelgarnDepartments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, T2N 4Z6, Canada.
David MoherClinical Epidemiology Program, Ottawa Hospital Research Institute and Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8L6, Canada.
Sumit R MajumdarDepartment of Medicine, University of Alberta, Edmonton, AB, T6G 2R3, Canada.
Sharon E StrausLi Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada Department of Geriatric Medicine, University of Toronto, Toronto, ON, M5S 1A1, Canada sharon.straus@utoronto.ca.
McMaster University · CAOttawa Hospital · CAUniversity of Alberta · CAUniversity of Calgary · CAUniversity of Ottawa · CAUniversity of Toronto · CA

Funding

Canadian Institutes of Health Research
6 · The paper itself

Abstract

objectiveTo examine the safety, effectiveness, and cost effectiveness of long acting insulin for type 1 diabetes.

designSystematic review and network meta-analysis. DATA SOURCES: Medline, Cochrane Central Register of Controlled Trials, Embase, and grey literature were searched through January 2013. STUDY SELECTION: Randomized controlled trials or non-randomized studies of long acting (glargine, detemir) and intermediate acting (neutral protamine Hagedorn (NPH), lente) insulin for adults with type 1 diabetes were included.

results39 studies (27 randomized controlled trials including 7496 patients) were included after screening of 6501 titles/abstracts and 190 full text articles. Glargine once daily, detemir once daily, and detemir once/twice daily significantly reduced hemoglobin A1c compared with NPH once daily in network meta-analysis (26 randomized controlled trials, mean difference -0.39%, 95% confidence interval -0.59% to -0.19%; -0.26%, -0.48% to -0.03%; and -0.36%, -0.65% to -0.08%; respectively). Differences in network meta-analysis were observed between long acting and intermediate acting insulin for severe hypoglycemia (16 randomized controlled trials; detemir once/twice daily versus NPH once/twice daily: odds ratio 0.62, 95% confidence interval 0.42 to 0.91) and weight gain (13 randomized controlled trials; detemir once daily versus NPH once/twice daily: mean difference 4.04 kg, 3.06 to 5.02 kg; detemir once/twice daily versus NPH once daily: -5.51 kg, -6.56 to -4.46 kg; glargine once daily versus NPH once daily: -5.14 kg, -6.07 to -4.21). Compared with NPH, detemir was less costly and more effective in 3/14 cost effectiveness analyses and glargine was less costly and more effective in 2/8 cost effectiveness analyses. The remaining cost effectiveness analyses found that detemir and glargine were more costly but more effective than NPH. Glargine was not cost effective compared with detemir in 2/2 cost effectiveness analyses.

conclusionsLong acting insulin analogs are probably superior to intermediate acting insulin analogs, although the difference is small for hemoglobin A1c. Patients and their physicians should tailor their choice of insulin according to preference, cost, and accessibility. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42013003610.

Indexed as

Cost-Benefit AnalysisDiabetes Mellitus, Type 1HumansHypoglycemic AgentsInsulin, Long-ActingHypoglycemic AgentsInsulin, Long-Acting

Identifiers

PMID25274009
PMCPMC4199252
OpenAlexW2100950755

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.