Short-acting insulin analogues versus regular human insulin on postprandial glucose and hypoglycemia in type 1 diabetes mellitus : a systematic review and meta-analysis

Detalhes bibliográficos
Autor(a) principal: Fagundes, Karla Fabiana Santana de Melo Cabral
Data de Publicação: 2019
Outros Autores: Bahia, Luciana Ribeiro, Pasinato, Bruna, Porfírio, Gustavo José Martiniano, Martimbianco, Ana Luiza Cabrera, Riera, Rachel, Calliari, Luís Eduardo Procopio, Minicucci, Walter Jose, Turatti, Luiz Alberto Andreotti, Pedrosa, Hermelinda Cordeiro, Schaan, Beatriz D'Agord
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UFRGS
Texto Completo: http://hdl.handle.net/10183/200508
Resumo: Introduction: Strict glucose control using multiple doses of insulin is the standard treatment for type 1 diabetes mellitus (T1DM), but increased risk of hypoglycemia is a frequent drawback. Regular insulin in multiple doses is important for achieving strict glycemic control for T1DM, but short-acting insulin analogues may be better in reducing hypoglycemia and postprandial glucose levels. Objective: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effects of short-acting insulin analogues vs regular human insulin on hypoglycemia and postprandial glucose in patients with T1DM. Methods: Searches were run on the electronic databases MEDLINE, Cochrane-CENTRAL, EMBASE, ClinicalTrials.gov, LILACS, and DARE for RCTs published until August 2017. To be included in the study, the RCTs had to cover a minimum period of 4 weeks and had to assess the effects of short-acting insulin analogues vs regular human insulin on hypoglycemia and postprandial glucose levels in patients with T1DM. Two independent reviewers extracted the data and assessed the quality of the selected studies. The primary outcomes analyzed were hypoglycemia (total episodes, nocturnal hypoglycemia, and severe hypoglycemia) and postprandial glucose (at all times, after breakfast, after lunch, and after dinner). Glycated hemoglobin (HbA1c) levels and quality of life were considered secondary outcomes. The risk of bias of each RCT was assessed using the Cochrane Collaboration Risk of Bias table, while the quality of evidence for each outcome was assessed using the GRADEpro software. The pooled mean difference in the number of hypoglycemic episodes and postprandial glucose between short-acting insulin analogues vs. regular human insulin was calculated using the random-effects model. Results: Of the 2897 articles retrieved, 22 (6235 patients) were included. Short-acting insulin analogues were associated with a decrease in total hypoglycemic episodes (risk rate 0.93, 95% CI 0.87–0.99; 6235 patients; I2 = 81%), nocturnal hypoglycemia (risk rate 0.55, 95% CI 0.40–0.76, 1995 patients, I2 = 84%), and severe hypoglycemia (risk rate 0.68, 95% CI 0.60–0.77; 5945 patients, I2 = 0%); and with lower postprandial glucose levels (mean difference/MD − 19.44 mg/dL; 95% CI − 21.49 to − 17.39; 5031 patients, I2 = 69%) and lower HbA1c (MD − 0,13%; IC 95% − 0.16 to − 0.10; 5204 patients; I2 = 73%) levels. Conclusions: Short-acting insulin analogues are superior to regular human insulin in T1DM patients for the following outcomes: total hypoglycemic episodes, nocturnal hypoglycemia, severe hypoglycemia, postprandial glucose, and HbA1c.
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spelling Fagundes, Karla Fabiana Santana de Melo CabralBahia, Luciana RibeiroPasinato, BrunaPorfírio, Gustavo José MartinianoMartimbianco, Ana Luiza CabreraRiera, RachelCalliari, Luís Eduardo ProcopioMinicucci, Walter JoseTuratti, Luiz Alberto AndreottiPedrosa, Hermelinda CordeiroSchaan, Beatriz D'Agord2019-10-11T03:54:41Z20191758-5996http://hdl.handle.net/10183/200508001100316Introduction: Strict glucose control using multiple doses of insulin is the standard treatment for type 1 diabetes mellitus (T1DM), but increased risk of hypoglycemia is a frequent drawback. Regular insulin in multiple doses is important for achieving strict glycemic control for T1DM, but short-acting insulin analogues may be better in reducing hypoglycemia and postprandial glucose levels. Objective: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effects of short-acting insulin analogues vs regular human insulin on hypoglycemia and postprandial glucose in patients with T1DM. Methods: Searches were run on the electronic databases MEDLINE, Cochrane-CENTRAL, EMBASE, ClinicalTrials.gov, LILACS, and DARE for RCTs published until August 2017. To be included in the study, the RCTs had to cover a minimum period of 4 weeks and had to assess the effects of short-acting insulin analogues vs regular human insulin on hypoglycemia and postprandial glucose levels in patients with T1DM. Two independent reviewers extracted the data and assessed the quality of the selected studies. The primary outcomes analyzed were hypoglycemia (total episodes, nocturnal hypoglycemia, and severe hypoglycemia) and postprandial glucose (at all times, after breakfast, after lunch, and after dinner). Glycated hemoglobin (HbA1c) levels and quality of life were considered secondary outcomes. The risk of bias of each RCT was assessed using the Cochrane Collaboration Risk of Bias table, while the quality of evidence for each outcome was assessed using the GRADEpro software. The pooled mean difference in the number of hypoglycemic episodes and postprandial glucose between short-acting insulin analogues vs. regular human insulin was calculated using the random-effects model. Results: Of the 2897 articles retrieved, 22 (6235 patients) were included. Short-acting insulin analogues were associated with a decrease in total hypoglycemic episodes (risk rate 0.93, 95% CI 0.87–0.99; 6235 patients; I2 = 81%), nocturnal hypoglycemia (risk rate 0.55, 95% CI 0.40–0.76, 1995 patients, I2 = 84%), and severe hypoglycemia (risk rate 0.68, 95% CI 0.60–0.77; 5945 patients, I2 = 0%); and with lower postprandial glucose levels (mean difference/MD − 19.44 mg/dL; 95% CI − 21.49 to − 17.39; 5031 patients, I2 = 69%) and lower HbA1c (MD − 0,13%; IC 95% − 0.16 to − 0.10; 5204 patients; I2 = 73%) levels. Conclusions: Short-acting insulin analogues are superior to regular human insulin in T1DM patients for the following outcomes: total hypoglycemic episodes, nocturnal hypoglycemia, severe hypoglycemia, postprandial glucose, and HbA1c.application/pdfengDiabetology & metabolic syndrome. London. vol. 11 (2019), 2, 13 p.InsulinasDiabetes mellitus tipo 1Diabetes mellitusType 1 diabetesInsulinAspart insulinGlulisine insulinLispro insulinSystematic reviewMeta-analysisShort-acting insulin analogues versus regular human insulin on postprandial glucose and hypoglycemia in type 1 diabetes mellitus : a systematic review and meta-analysisEstrangeiroinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFRGSinstname:Universidade Federal do Rio Grande do Sul (UFRGS)instacron:UFRGSTEXT001100316.pdf.txt001100316.pdf.txtExtracted Texttext/plain52317http://www.lume.ufrgs.br/bitstream/10183/200508/2/001100316.pdf.txteed525a87f1897f04ff9ff5380e33532MD52ORIGINAL001100316.pdfTexto completo (inglês)application/pdf1943619http://www.lume.ufrgs.br/bitstream/10183/200508/1/001100316.pdf44c336db85057cf499a5bd1c6b2a8e84MD5110183/2005082019-10-12 03:53:31.025523oai:www.lume.ufrgs.br:10183/200508Repositório de PublicaçõesPUBhttps://lume.ufrgs.br/oai/requestopendoar:2019-10-12T06:53:31Repositório Institucional da UFRGS - Universidade Federal do Rio Grande do Sul (UFRGS)false
dc.title.pt_BR.fl_str_mv Short-acting insulin analogues versus regular human insulin on postprandial glucose and hypoglycemia in type 1 diabetes mellitus : a systematic review and meta-analysis
title Short-acting insulin analogues versus regular human insulin on postprandial glucose and hypoglycemia in type 1 diabetes mellitus : a systematic review and meta-analysis
spellingShingle Short-acting insulin analogues versus regular human insulin on postprandial glucose and hypoglycemia in type 1 diabetes mellitus : a systematic review and meta-analysis
Fagundes, Karla Fabiana Santana de Melo Cabral
Insulinas
Diabetes mellitus tipo 1
Diabetes mellitus
Type 1 diabetes
Insulin
Aspart insulin
Glulisine insulin
Lispro insulin
Systematic review
Meta-analysis
title_short Short-acting insulin analogues versus regular human insulin on postprandial glucose and hypoglycemia in type 1 diabetes mellitus : a systematic review and meta-analysis
title_full Short-acting insulin analogues versus regular human insulin on postprandial glucose and hypoglycemia in type 1 diabetes mellitus : a systematic review and meta-analysis
title_fullStr Short-acting insulin analogues versus regular human insulin on postprandial glucose and hypoglycemia in type 1 diabetes mellitus : a systematic review and meta-analysis
title_full_unstemmed Short-acting insulin analogues versus regular human insulin on postprandial glucose and hypoglycemia in type 1 diabetes mellitus : a systematic review and meta-analysis
title_sort Short-acting insulin analogues versus regular human insulin on postprandial glucose and hypoglycemia in type 1 diabetes mellitus : a systematic review and meta-analysis
author Fagundes, Karla Fabiana Santana de Melo Cabral
author_facet Fagundes, Karla Fabiana Santana de Melo Cabral
Bahia, Luciana Ribeiro
Pasinato, Bruna
Porfírio, Gustavo José Martiniano
Martimbianco, Ana Luiza Cabrera
Riera, Rachel
Calliari, Luís Eduardo Procopio
Minicucci, Walter Jose
Turatti, Luiz Alberto Andreotti
Pedrosa, Hermelinda Cordeiro
Schaan, Beatriz D'Agord
author_role author
author2 Bahia, Luciana Ribeiro
Pasinato, Bruna
Porfírio, Gustavo José Martiniano
Martimbianco, Ana Luiza Cabrera
Riera, Rachel
Calliari, Luís Eduardo Procopio
Minicucci, Walter Jose
Turatti, Luiz Alberto Andreotti
Pedrosa, Hermelinda Cordeiro
Schaan, Beatriz D'Agord
author2_role author
author
author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Fagundes, Karla Fabiana Santana de Melo Cabral
Bahia, Luciana Ribeiro
Pasinato, Bruna
Porfírio, Gustavo José Martiniano
Martimbianco, Ana Luiza Cabrera
Riera, Rachel
Calliari, Luís Eduardo Procopio
Minicucci, Walter Jose
Turatti, Luiz Alberto Andreotti
Pedrosa, Hermelinda Cordeiro
Schaan, Beatriz D'Agord
dc.subject.por.fl_str_mv Insulinas
Diabetes mellitus tipo 1
topic Insulinas
Diabetes mellitus tipo 1
Diabetes mellitus
Type 1 diabetes
Insulin
Aspart insulin
Glulisine insulin
Lispro insulin
Systematic review
Meta-analysis
dc.subject.eng.fl_str_mv Diabetes mellitus
Type 1 diabetes
Insulin
Aspart insulin
Glulisine insulin
Lispro insulin
Systematic review
Meta-analysis
description Introduction: Strict glucose control using multiple doses of insulin is the standard treatment for type 1 diabetes mellitus (T1DM), but increased risk of hypoglycemia is a frequent drawback. Regular insulin in multiple doses is important for achieving strict glycemic control for T1DM, but short-acting insulin analogues may be better in reducing hypoglycemia and postprandial glucose levels. Objective: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effects of short-acting insulin analogues vs regular human insulin on hypoglycemia and postprandial glucose in patients with T1DM. Methods: Searches were run on the electronic databases MEDLINE, Cochrane-CENTRAL, EMBASE, ClinicalTrials.gov, LILACS, and DARE for RCTs published until August 2017. To be included in the study, the RCTs had to cover a minimum period of 4 weeks and had to assess the effects of short-acting insulin analogues vs regular human insulin on hypoglycemia and postprandial glucose levels in patients with T1DM. Two independent reviewers extracted the data and assessed the quality of the selected studies. The primary outcomes analyzed were hypoglycemia (total episodes, nocturnal hypoglycemia, and severe hypoglycemia) and postprandial glucose (at all times, after breakfast, after lunch, and after dinner). Glycated hemoglobin (HbA1c) levels and quality of life were considered secondary outcomes. The risk of bias of each RCT was assessed using the Cochrane Collaboration Risk of Bias table, while the quality of evidence for each outcome was assessed using the GRADEpro software. The pooled mean difference in the number of hypoglycemic episodes and postprandial glucose between short-acting insulin analogues vs. regular human insulin was calculated using the random-effects model. Results: Of the 2897 articles retrieved, 22 (6235 patients) were included. Short-acting insulin analogues were associated with a decrease in total hypoglycemic episodes (risk rate 0.93, 95% CI 0.87–0.99; 6235 patients; I2 = 81%), nocturnal hypoglycemia (risk rate 0.55, 95% CI 0.40–0.76, 1995 patients, I2 = 84%), and severe hypoglycemia (risk rate 0.68, 95% CI 0.60–0.77; 5945 patients, I2 = 0%); and with lower postprandial glucose levels (mean difference/MD − 19.44 mg/dL; 95% CI − 21.49 to − 17.39; 5031 patients, I2 = 69%) and lower HbA1c (MD − 0,13%; IC 95% − 0.16 to − 0.10; 5204 patients; I2 = 73%) levels. Conclusions: Short-acting insulin analogues are superior to regular human insulin in T1DM patients for the following outcomes: total hypoglycemic episodes, nocturnal hypoglycemia, severe hypoglycemia, postprandial glucose, and HbA1c.
publishDate 2019
dc.date.accessioned.fl_str_mv 2019-10-11T03:54:41Z
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dc.relation.ispartof.pt_BR.fl_str_mv Diabetology & metabolic syndrome. London. vol. 11 (2019), 2, 13 p.
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