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    Efficacy and safety of insulin in type 2 diabetes: meta-analysis of randomised controlled trials

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    graham64
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    Efficacy and safety of insulin in type 2 diabetes: meta-analysis of randomised controlled trials

    Post by graham64 on Sun Sep 11 2016, 21:13

    Abstract

    BACKGROUND: It is essential to anticipate and limit the social, economic and sanitary cost of type 2 diabetes (T2D), which is in constant progression worldwide. When blood glucose targets are not achieved with diet and lifestyle intervention, insulin is recommended whether or not the patient is already taking hypoglycaemic drugs. However, the benefit/risk balance of insulin remains controversial. Our aim was to determine the efficacy and safety of insulin vs. hypoglycaemic drugs or diet/placebo on clinically relevant endpoints.

    METHODS: A systematic literature review (Pubmed, Embase, Cochrane Library) including all randomised clinical trials (RCT) analysing insulin vs. hypoglycaemic drugs or diet/placebo, published between 1950 and 2013, was performed. We included all RCTs reporting effects on all-cause mortality, cardiovascular mortality, death by cancer, cardiovascular morbidity, microvascular complications and hypoglycaemia in adults ≥ 18 years with T2D. Two authors independently assessed trial eligibility and extracted the data. Internal validity of studies was analyzed according to the Cochrane Risk of Bias tool. Risk ratios (RR) with 95 % confidence intervals (95 % CI) were calculated, using the fixed effect model in first approach. The I(2) statistic assessed heterogeneity. In case of statistical heterogeneity, subgroup and sensitivity analyses then a random effect model were performed. The alpha threshold was 0.05. Primary outcomes were all-cause mortality and cardiovascular mortality. Secondary outcomes were non-fatal cardiovascular events, hypoglycaemic events, death from cancer, and macro- or microvascular complications.

    RESULTS: Twenty RCTs were included out of the 1632 initially identified studies. 18 599 patients were analysed: Insulin had no effect vs. hypoglycaemic drugs on all-cause mortality RR = 0.99 (95 % CI =0.92-1.06) and cardiovascular mortality RR = 0.99 (95 % CI =0.90-1.09), nor vs. diet/placebo RR = 0.92 (95 % CI = 0.80-1.07) and RR = 0.95 (95 % CI 0.77-1.18) respectively. No effect was found on secondary outcomes either. However, severe hypoglycaemia was more frequent with insulin compared to hypoglycaemic drugs RR = 1.70 (95 % CI = 1.51-1.91).

    CONCLUSIONS: There is no significant evidence of long term efficacy of insulin on any clinical outcome in T2D. However, there is a trend to clinically harmful adverse effects such as hypoglycaemia and weight gain. The only benefit could be limited to reducing short term hyperglycemia. This needs to be confirmed with further studies.

    Full text here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939045/


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    chris c
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    Re: Efficacy and safety of insulin in type 2 diabetes: meta-analysis of randomised controlled trials

    Post by chris c on Mon Sep 12 2016, 19:58

    Hmmmm, I was just reading a study elsewhere (Dr Briffa?) which showed an increase in CVD with insulin use.

    I guess the problem would be using insulin in people with high IR, when doses can be massive, versus using it in people whose pancreas is largely burned out, when it is at levels just replacing what is no longer there.

    Pity the NHS seldom checks insulin levels except in diagnosed Type 1s. It might be eye-opening to see what shows up not only in Type 2s but in "nondiabetics"

      Current date/time is Tue Sep 26 2017, 20:46