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Ultra‐rapid‐acting insulins for adults with diabetes: A systematic review and meta‐analysis
Author(s) -
Avgerinos Ioannis,
Papanastasiou Georgia,
Karagiannis Thomas,
Michailidis Theodoros,
Liakos Aris,
Mainou Maria,
Matthews David R.,
Tsapas Apostolos,
Bekiari Eleni
Publication year - 2021
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.14461
Subject(s) - medicine , postprandial , meta analysis , type 2 diabetes , insulin aspart , diabetes mellitus , confidence interval , odds ratio , randomized controlled trial , insulin lispro , adverse effect , clinical endpoint , insulin , endocrinology
We performed a systematic review and meta‐analysis of randomized controlled trials to assess the efficacy and safety of the novel, ultra‐rapid‐acting insulins aspart and lispro in adults with type 1 or type 2 diabetes. Our primary outcome was change in HbA1c from baseline. We additionally assessed eight efficacy and six safety endpoints. We calculated weighted mean differences (WMD) for continuous outcomes and odds ratios (ORs) for dichotomous outcomes, alongside 95% confidence intervals (CIs). We additionally assessed statistical heterogeneity among studies with the I 2 statistic, considering values greater than 60% as indicative of substantial heterogeneity. Nine studies comprising 5931 patients were included in the systematic review; eight active‐controlled studies could be synthesized in terms of a meta‐analysis. Treatment with ultra‐rapid‐acting insulins had a similar effect on change in HbA1c compared with rapid‐acting insulins (WMD −0.02%, 95% CI −0.08 to 0.05, I 2 = 61% for patients with type 1 diabetes and −0.02%, 95% CI −0.09 to 0.04, I 2 = 19% for patients with type 2 diabetes). Similarly, no difference was evident in terms of change in fasting plasma glucose, self‐measured plasma glucose, body weight, basal or bolus insulin dose, incidence of serious adverse events and hypoglycaemia. Compared with rapid‐acting insulins, ultra‐rapid‐acting insulins reduced 1‐ and 2‐hour postprandial glucose (PPG) increment based on a liquid meal test, both in patients with type 1 and type 2 diabetes (WMD −0.94 mmol/L, 95% CI −1.17 to −0.72, I 2 = 0% and −0.56 mmol/L, 95% CI −0.79 to −0.32, I 2 = 0%, respectively, for change in 1‐hour PPG increment). In conclusion, ultra‐rapid‐acting insulins were as efficacious and safe as rapid‐acting insulins, showing a favourable effect solely on PPG control.