DTB questions first-line use of insulin analogues
The latest issue of Drug and Therapeutics Bulletin questions the first-line use of insulin analogues (2004;42:77).
DTB reviewed 42 studies comparing short-acting analogues with conventional
insulin. The review found that the use of short-acting analogues led
to a small decrease in HbA1c levels in patients with type 1 diabetes,
but not type 2, and although the overall frequency of hypoglycaemia was
not reduced, severe hypoglycaemia occurred less often.
DTB also reviewed studies looking at the longer-acting analogues detemir
and glargine. Patients treated with insulin detemir show similar HbA1c levels to those on isophane insulin, although detemir appears to reduce
nocturnal hypoglycaemia in patients with type 1 diabetes.
Insulin glargine, which is used once daily, seems to reduce nocturnal
hypoglycaemia in patients with type 1 or 2 diabetes. It also appears
to reduce fasting blood or plasma glucose concentrations in patients
with type 1 diabetes. However, there is inconclusive evidence that it
reduces HbA1c levels in patients with type 1 diabetes or HbA1c levels
and frequency of mild symptomatic hypoglycaemic events in patients with
type 2 diabetes.
Ike Iheanacho, editor, DTB, said: “On current evidence, insulin
analogues represent a useful option for patients who experience problematic
hypoglycaemia. Further research is needed to justify their first-line
use in preference to longer-established conventional types of insulin.”
The latest issue of DTB also features a review of laser treatment for
skin problems. |
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