Efficacy and safety of insulin in type 2 diabetes: meta-analysis of randomised controlled trials.

Published on Jul 8, 2016in BMC Endocrine Disorders1.994
· DOI :10.1186/S12902-016-0120-Z
Sylvie Erpeldinger6
Estimated H-index: 6
Michaela Beatrice Rehman2
Estimated H-index: 2
+ 9 AuthorsRémy Boussageon11
Estimated H-index: 11
(University of Poitiers)
Background It is essential to anticipate and limit the social, economic and sanitary cost of type 2 diabetes (T2D), which is in constant progression worldwide. When blood glucose targets are not achieved with diet and lifestyle intervention, insulin is recommended whether or not the patient is already taking hypoglycaemic drugs. However, the benefit/risk balance of insulin remains controversial. Our aim was to determine the efficacy and safety of insulin vs. hypoglycaemic drugs or diet/placebo on clinically relevant endpoints.
📖 Papers frequently viewed together
5,575 Citations
3,305 Citations
13 Citations
#1Silvio E. Inzucchi (Yale University)H-Index: 97
Last. David R. Matthews (NIHR: National Institute for Health Research)H-Index: 84
view all 10 authors...
470 CitationsSource
#1Silvio E. Inzucchi (Yale University)H-Index: 97
Last. David R. Matthews (NIHR: National Institute for Health Research)H-Index: 84
view all 10 authors...
In 2012, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) published a position statement on the management of hyperglycemia in patients with type 2 diabetes (1,2). This was needed because of an increasing array of antihyperglycemic drugs and growing uncertainty regarding their proper selection and sequence. Because of a paucity of comparative effectiveness research on long-term treatment outcomes with many of these medications, the 2012 public...
2,203 CitationsSource
#1Sarah E. Holden (Cardiff University)H-Index: 13
#2E.A.M. Gale (UoB: University of Bristol)H-Index: 1
Last. Craig John Currie (Cardiff University)H-Index: 31
view all 4 authors...
Aims: We set out to estimate the prevalence rate of insulin use in the UK population, the total number of people in the UK who use insulin, the proportion of users with type 1 and type 2 diabetes and changes between 1991 and 2010. Methods: Patients receiving prescriptions for insulin were identified in the Clinical Practice Research Datalink and attributed a diagnosis of type 1 or type 2 diabetes. The annual prevalence of insulin use was calculated and applied to population data. Results: The cr...
30 CitationsSource
#1Andrew I. Geller (CDC: Centers for Disease Control and Prevention)H-Index: 15
#2Nadine Shehab (CDC: Centers for Disease Control and Prevention)H-Index: 24
Last. Daniel S. Budnitz (CDC: Centers for Disease Control and Prevention)H-Index: 29
view all 7 authors...
Importance Detailed, nationally representative data describing high-risk populations and circumstances involved in insulin-related hypoglycemia and errors (IHEs) can inform approaches to individualizing glycemic targets. Objective To describe the US burden, rates, and characteristics of emergency department (ED) visits and emergency hospitalizations for IHEs. Design, Setting, and Participants Nationally representative public health surveillance of adverse drug events among insulin-treated patien...
188 CitationsSource
#1Matteo MonamiH-Index: 57
#2Stefano GenoveseH-Index: 32
Last. Edoardo MannucciH-Index: 98
view all 3 authors...
Aim Cardiovascular safety of sulfonylurea has been questioned by some authors. This article aims at collecting all available data on this issue from randomized trials. Methods A meta-analysis was performed including all trials with a duration of at least 6 months, comparing a sulfonylurea with a non-sulfonylurea agent in type 2 diabetes. Major cardiovascular events (MACE) and mortality were retrieved and combined to calculate Mantel-Haenzel odds ratio (MH-OR). Results Of the 115 selected trials,...
176 CitationsSource
#1Rémy Boussageon (UCBL: Claude Bernard University Lyon 1)H-Index: 11
#2Irène Supper (UCBL: Claude Bernard University Lyon 1)H-Index: 7
Last. François Gueyffier (UCBL: Claude Bernard University Lyon 1)H-Index: 40
view all 8 authors...
Background Open-label, randomized controlled trials (RCTs) are subject to observer bias. If patient management is conducted without blinding, a difference between groups may be explained by other factors than study treatment. One factor may come from taking concomitant treatments with an efficacy on the studied outcomes. In type 2 diabetes, some antihypertensive or lipid-lowering drugs are effective against diabetic complications. We wanted to determine if these concomitant treatments were corre...
7 CitationsSource
#1Rajesh Garg (Brigham and Women's Hospital)H-Index: 34
#2Shelley HurwitzH-Index: 62
Last. Apoorva TrivediH-Index: 3
view all 4 authors...
OBJECTIVE Hypoglycemia is associated with increased mortality in hospitalized patients. We investigated the relationship between spontaneous hypoglycemia versus insulin-associated hypoglycemia and mortality in hospitalized patients. RESEARCH DESIGN AND METHODS Data for this retrospective cohort study were obtained from electronic databases of patients admitted between 1 April 2008 and 30 November 2010. Patients with one or more blood glucose values ≤50 mg/dL on point-of-care glucose testing were...
117 CitationsSource
#1Michael A. NauckH-Index: 97
#2Edward S. Horton (Joslin Diabetes Center)H-Index: 88
Last. Raffaella Balena (Hoffmann-La Roche)H-Index: 8
view all 7 authors...
Aims To compare the efficacy and safety of once-weekly taspoglutide with insulin glargine in patients with advanced Type 2 diabetes failing metformin and sulphonylurea combination therapy. Methods This open-label, parallel-group, multi-centre trial randomized 1049 patients continuing metformin 1:1:1 to taspoglutide 10 mg once weekly, taspoglutide 20 mg once weekly or insulin glargine once daily with forced titration to fasting plasma glucose ≤ 6.1 mmol/l. Sulphonylureas were discontinued before ...
26 CitationsSource
#1S.-C. Liu (Mackay Memorial Hospital)H-Index: 1
#2Yu-Kang Tu (University of Leeds)H-Index: 54
Last. Kuo-Liong Chien (NTU: National Taiwan University)H-Index: 62
view all 4 authors...
Aim: Most guidelines recommend metformin as first-line therapy in patients with type 2 diabetes. However, the choice of a second-line drug lacks consistent consensus. We aimed to assess available information of antidiabetic drugs added to metformin on the change in glycated haemoglobin A1c (A1C), risk of hypoglycaemia and change in body weight. Methods: PubMed and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials (RCTs) written in English through Decem...
144 CitationsSource
#1Origin Trial Investigators (Population Health Research Institute)H-Index: 6
#2Hertzel C. Gerstein (Population Health Research Institute)H-Index: 118
Last. Salim Yusuf (Population Health Research Institute)H-Index: 247
view all 13 authors...
BACKGROUND: The provision of sufficient basal insulin to normalize fasting plasma glucose levels may reduce cardiovascular events, but such a possibility has not been formally tested. METHODS: We randomly assigned 12,537 people (mean age, 63.5 years) with cardiovascular risk factors plus impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes to receive insulin glargine (with a target fasting blood glucose level of ≤95 mg per deciliter [5.3 mmol per liter]) or standard care and ...
1,170 CitationsSource
Cited By30
#1Christian Ott (Paracelsus Private Medical University of Salzburg)H-Index: 32
#2Susanne Jung (FAU: University of Erlangen-Nuremberg)H-Index: 3
Last. Roland E. Schmieder (FAU: University of Erlangen-Nuremberg)H-Index: 108
view all 10 authors...
Type 2 diabetes causes cardio-renal complications and is treated with different combination therapies. The renal hemodynamics profile of such combination therapies has not been evaluated in detail. Patients (N = 97) with type 2 diabetes were randomized to receive either empagliflozin and linagliptin (E+L group) or metformin and insulin glargine (M+I group) for 3 months. Renal hemodynamics were assessed with para-aminohippuric acid and inulin for renal plasma flow (RPF) and glomerular filtration ...
#1Mireille A EdensH-Index: 4
#2Peter R van Dijk (UMCG: University Medical Center Groningen)H-Index: 11
Last. Henk J. G. Bilo (UMCG: University Medical Center Groningen)H-Index: 61
view all 4 authors...
Aims The aim of this study was to explore the effect of insulin treatment initiation on weight by taking weight change prior to initiation into account. Materials and methods We performed an observational retrospective inception cohort study, concerning Dutch primary care. We identified all patients that initiated insulin treatment (n = 7967) and individually matched patients with a reference patient (n = 5213 pairs). We obtained estimated mean weight changes in the five years prior to five year...
#1Dimitris Rucks Varvaki Rados (UFRGS: Universidade Federal do Rio Grande do Sul)H-Index: 9
#2Mariana Rangel Ribeiro Falcetta (UFRGS: Universidade Federal do Rio Grande do Sul)H-Index: 2
Last. in memoriam (UFRGS: Universidade Federal do Rio Grande do Sul)
view all 5 authors...
Abstract Aim To evaluate the risk of all-cause and cardiovascular mortality, acute myocardial infarction, and stroke associated with insulin treatment in patients with type 2 diabetes. Methods A systematic review with meta-analysis of randomized clinical trials (RCTs) was performed. EMBASE, Cochrane, and PubMed databases were searched for RCTs reporting mortality or cardiovascular events and comparing basal insulin to any treatment in patients with type 2 diabetes. Data were summarized with Mant...
#1Benedetta Maria Bonora (UNIPD: University of Padua)H-Index: 17
#2Mauro RigatoH-Index: 12
Last. Gian Paolo Fadini (UNIPD: University of Padua)H-Index: 67
view all 10 authors...
Abstract Aims We evaluated de-intensification of basal-bolus insulin (BBI) after initiation of a GLP-1 receptor agonist (GLP-1RA) under routine care. Research Design and Methods This retrospective, multicenter study conducted at outpatient clinics in North-East Italy collected data on patients with T2D on BBI who initiated a GLP-1RA. Patients were divided according to whether they de-intensified BBI at the end of observation by stopping prandial insulin. Results We included 425 patients with mea...
#1Joanna Khatib (Tulane University)H-Index: 1
#2Yixue Shao (Tulane University)
Last. Vivian Fonseca (Tulane University)H-Index: 77
view all 4 authors...
Objective We conducted a meta-analysis to compare major adverse cardiovascular events (MACEs) in recent diabetes type 2 drugs cardiovascular outcome trials (CVOTs) in the subgroups that used insulin at baseline to the subgroups that did not. Methods English publications from 2010 to 2019 were searched in PubMed and Google Scholar. We searched published clinical trials for CVOTs with new drugs for type 2 diabetes and found 12 publications, of which 8 provided outcomes according to insulin use. We...
Abstract Cardiovascular (CV) benefits of SGLT-2 inhibitors (SGLT-2i) have been consistent in type 2 diabetes mellitus (T2DM). To find whether SGLT-2i show similar CV effects with insulin therapy in T2DM, we conducted a trial-level meta-analysis of CV outcome trials. This meta-analysis found SGLT-2i exert CV benefit, irrespective of background insulin therapy.
#1Eugene E. WrightH-Index: 2
#2Vanita R. Aroda (Brigham and Women's Hospital)H-Index: 33
Injectable therapies such as glucagon-like peptide-1 receptor agonists (GLP-1RAs) and insulin are high-efficacy options for people with type 2 diabetes (T2D) who require treatment intensification. ...
5 CitationsSource
#1Ruth Paterson (Edinburgh Napier University)H-Index: 5
#2Laurence Taggart (Ulster University)H-Index: 20
Last. Michael E. Brown ('QUB': Queen's University Belfast)H-Index: 94
view all 4 authors...
AIM To compare the frequency and factors associated with diabetes medication-taking (depression, perceived side effects, self-efficacy and social support) in people with mild to moderate intellectual disability and those without intellectual disability. METHODS In stage 1 of this study, we collated information on diabetes medication-taking and associated factors in 111 people with diabetes: 33 adults with mild to moderate intellectual disability and 78 adults without intellectual disability. Val...
1 CitationsSource
2 CitationsSource
#1Diletta Fabrizi (University of Milano-Bicocca)H-Index: 2
#2Paola Rebora (University of Milano-Bicocca)H-Index: 19
Last. Davide Ausili (University of Milano-Bicocca)H-Index: 11
view all 6 authors...
To evaluate how self-care maintenance, self-care monitoring, and self-care management affect glycated haemoglobin in type 2 diabetes mellitus patients and to set cut-off points of the Self-Care of Diabetes Inventory scales using glycated haemoglobin as outcome of interest. A secondary analysis of a previous multicentre observational cross-sectional study was conducted. Overall, 540 adults with type 2 diabetes mellitus confirmed diagnosis were involved. Socio-demographic and clinical data were co...
2 CitationsSource