Monami Matteo, Marchionni Niccolò, Mannucci Edoardo
Section of Geriatric Cardiology, Department of Cardiovascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Via delle Oblate 4, 50141 Florence, Italy.
Diabetes Res Clin Pract. 2008 Aug;81(2):184-9. doi: 10.1016/j.diabres.2008.04.007. Epub 2008 May 20.
Long-acting insulin analogues, in comparison with NPH insulin, should warrant a greater reproducibility of absorption after subcutaneous injection, providing better metabolic control with reduced hypoglycaemic risk. Aim of the present meta-analysis is the assessment of differences with respect to HbA1c, incidence of hypoglycaemia, weight gain, between NPH human insulin and each long-acting analogue.
All randomized controlled trials (RCTs) with a duration >12 weeks comparing long-acting insulin analogues (detemir or glargine) with NPH insulin in type 2 diabetic patients were retrieved; data on HbA1c and BMI at endpoint, and incidence of any, symptomatic, nocturnal, and severe hypoglycaemia, were extracted and meta-analysed.
A total of 14 RCTs was retrieved and included in the analysis. Long-acting analogues did not produce any significant improvement of HbA1c, in comparison with NPH human insulin. When trials with different analogues were analysed separately, NPH showed a significant superiority (by 0.1%) over detemir, but not over glargine. When analysing the effect of long-acting analogues on body weight, detemir, but not glargine, was associated with a significantly smaller weight gain than human insulin Both analogues were associated with a reduced risk for nocturnal and symptomatic hypoglycaemia (OR: 0.46[0.38-0.55] and 0.69[0.60-0.80]; all p<0.01).
Long-acting insulin analogues in type 2 diabetic patients does not seem to provide a better glycemic control in comparison with NPH insulin, whereas it reduces the risk of nocturnal and symptomatic hypoglycemia. Detemir, but not glargine, could be associated with smaller weight gain than NPH insulin.
与中性鱼精蛋白锌胰岛素（NPH胰岛素）相比，长效胰岛素类似物皮下注射后吸收的重复性应更高，能提供更好的代谢控制，同时降低低血糖风险。本荟萃分析的目的是评估NPH人胰岛素与每种长效类似物在糖化血红蛋白（HbA1c）、低血糖发生率、体重增加方面的差异。
检索了所有持续时间超过12周、比较长效胰岛素类似物（地特胰岛素或甘精胰岛素）与NPH胰岛素治疗2型糖尿病患者的随机对照试验（RCT）；提取终点时HbA1c和体重指数（BMI）的数据，以及任何、有症状、夜间和严重低血糖的发生率，并进行荟萃分析。
共检索到14项RCT并纳入分析。与NPH人胰岛素相比，长效类似物并未使HbA1c有任何显著改善。当分别分析不同类似物的试验时，NPH显示出比地特胰岛素有显著优势（高0.1%），但比甘精胰岛素没有优势。在分析长效类似物对体重的影响时，地特胰岛素（而非甘精胰岛素）与比人胰岛素显著更小的体重增加相关。两种类似物均与夜间和有症状低血糖风险降低相关（比值比：0.46[0.38 - 0.55]和0.69[0.60 - 0.80]；所有p<0.01）。
与NPH胰岛素相比，2型糖尿病患者使用长效胰岛素类似物似乎并未提供更好的血糖控制，但其降低了夜间和有症状低血糖的风险。地特胰岛素（而非甘精胰岛素）可能与比NPH胰岛素更小的体重增加相关。
