Clinical efficacy and safety of insulin aspart compared with regular human insulin in patients with type 1 and type 2 diabetes: a systematic review and meta-analysis

被引:11
|
作者
Wojciechowski, Piotr [1 ]
Niemczyk-Szechowska, Patrycja [1 ]
Olewinska, Elzbieta [1 ]
Jaros, Patrycja [1 ]
Mierzejewska, Barbara [2 ]
Skarzynska-Duk, Joanna [2 ]
Malecki, Maciej T. [3 ,4 ]
Rys, Przemyslaw [1 ]
机构
[1] HTA Consulting, Krakow, Poland
[2] Novo Nordisk Pharma, Warsaw, Poland
[3] Jagiellonian Univ, Dept Metab Dis, Coll Med, Krakow, Poland
[4] Univ Hosp, Krakow, Poland
来源
POLSKIE ARCHIWUM MEDYCYNY WEWNETRZNEJ-POLISH ARCHIVES OF INTERNAL MEDICINE | 2015年 / 125卷 / 03期
关键词
insulin aspart; insulin therapy; rapid-acting insulin analog; type 1 diabetes mellitus; type 2 diabetes mellitus; BASAL-BOLUS REGIMEN; METABOLIC-CONTROL; MEALTIME INSULIN; GLUCOSE CONTROL; NPH INSULIN; HYPOGLYCEMIA; MANAGEMENT; MELLITUS; ANALOGS; QUALITY;
D O I
10.20452/pamw.2705
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
INTRODUCTION Prandial insulin is a key component in insulin treatment of type 1 diabetes mellitus (T1DM) and in many patients with type 2 diabetes mellitus (T2DM). The evidence-based data supporting the choice of an insulin preparation are still limited. OBJECTIVES We performed a systematic review to summarize and update the evidence on relative efficacy and safety of insulin aspart (IAsp) and regular human insulin (RHI) in both types of diabetes. METHODS Randomized controlled trials comparing IAsp with RHI in patients with either T1DM or T2DM and conducted until May 2013 were retrieved from a systematic search of MEDLINE, EMBASE, and Cochrane Library. RESULTS Of 16 relevant trials, 11 involved patients with T1DM and 5-with T2DM. In the T1DM population, IAsp, when compared with RHI, provided a greater reduction in hemoglobin A(1c) (HbA(1c)) levels (weighted mean difference [WMD], -0.11%; 95% confidence interval [CI], -0.16 to -0.05; WMD, -1.2 mmol/mol; 95% CI, -1.7 to -0.5), and improved postprandial glucose levels following breakfast (WMD, -1.40 mmol/l; 95% CI, -1.72 to -1.07), lunch (WMD, -1.01 mmol/l; 95% CI, -1.61 to -0.41), and dinner (WMD, -0.89 mmol/l; 95% CI, -1.19 to -0.59). The risk of nocturnal hypoglycemia was lower in T1DM patients receiving IAsp (relative risk, 0.76; 95% CI, 0.64-0.91), while no difference was observed for severe hypoglycemia. In T2DM patients, IAsp led to a greater reduction in HbA(1c) levels (WMD, -0.22%; 95% CI, -0.39 to -0.05; -2.4 mmol/mol, -4.3 to -0.5) and postprandial blood glucose. The risk of overall hypoglycemia and severe adverse effects was comparable between the groups. CONCLUSIONS IAsp provides better glycemic control when compared with RHI in patients with T1DM and T2DM. Fewer T1DM patients treated with IAsp experienced nocturnal hypoglycemia, while both interventions showed a comparable risk of severe hypoglycemic events in both types of diabetes.
引用
收藏
页码:141 / 151
页数:11
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