Zhang XW, et al. - This meta-analysis was performed to determine the safety and efficacy of insulin degludec vs glargine in patients with type 1 (T1D) and type 2 (T2D) diabetes mellitus. In reducing hypoglycemic events, insulin degludec appeared to have a better safety with similar efficacy compared with insulin glargine.

Methods

• Until July 5, 2017, databases were searched.
• Randomized controlled trials comparing degludec with glargine in diabetic patients, each with a minimum of 16 weeks of follow-up, were included.

Results

• The researchers included 18 trials with 16,791 patients.
• Irrespective of the pooled diabetic populations and follow-up durations, degludec was correlated with a statistically significant reduction in risk for all confirmed hypoglycemia at the maintenance treatment period [estimated rate ratio (ERR) 0.81; 95% confidence interval (CI) 0.72-0.92; P=0.001], nocturnal confirmed hypoglycemia at the entire (ERR 0.71; 95% CI 0.63-0.80; P < 0.001) and maintenance treatment period (ERR 0.65; 95% CI 0.59-0.71; P < 0.001).
• The rate of hypoglycemia differed more prominently in the nocturnal period and maintenance period and in T2D than T1D patients.
• In T2D, degludec reduced the incidence of severe hypoglycemia [ERR 0.65; (0.52; 0.89); P=0.005] but not in T1D patients.
• In degludec, HbA1c concentration was slightly higher over glargine but was not clinically relevant [estimated treatment difference (ETD) 0.03; 95% CI -0.00 to 0.06%; P=0.06].
• Among degludec-treated patients, fasting plasma glucose level was lower (ETD -0.28 mmol/L; 95% CI -0.44 to -0.11 mmol/L; P=0.001).
• Several subgroup analyses demonstrated largely consistent findings.
• Between 2 treatment strategies, the rates of adverse events (total mortality and cardiovascular events) were not significantly different.