Review finds little evidence of benefit for insulin analogs over NPH insulin

Picture of a syringe

A systematic review comparing insulin analogues (glargine and detemir) with NPH insulin was published at the end of 2011.

Clinical question:

In type 1 diabetes, are insulin analogues better than NPH insulin?

It is not clear what outcomes were specified in advance of the study.

The evidence:

The reviewers found 8 randomised trials comparing glargine with NPH insulin, 9 comparing detemir with NPH and two directly comparing glargine with detemir.

When they pooled the data from these studies, the found no clinically or statistically significant differences in HbA1c for any of the comparisons.

Appraisal hints:

  • It is not clear which databases they searched.
  • Nor is it clear what the methodological quality of the studies was.
  • It is not clear what adverse events were looked at.
  • Further, longer term research is needed.


Sanches AC, Correr CJ, Venson R, Pontarolo R.  Revisiting the efficacy of long-acting insulin analogues on adults with type 1 diabetes using mixed-treatment comparisons. Diabetes Res Clin Pract. 2011 Dec;94(3):333-9. Epub 2011 Oct 11.

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I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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