Table 5 Overview of systematic reviews
Cochrane | NICE | Martin | |
|---|---|---|---|
Number of RCTs included | n = 26 | n = 51 | n = 31 |
Methods | Random effects model meta-analysis | Network Meta-analysis | Network Metanalysis |
Search date | 24 August 2020 | Unclear. Most recent study from 2018 | January 2021. Most recent study from 2018 |
Review question/scope | To compare the effects of long-term treatment with (ultra-)long-acting insulin analogues to NPH insulin (neutral protamine Hagedorn) or another (ultra-)long-acting insulin analogue in people with type 1 diabetes mellitus | Detemir versus degludec versus glargine versus NPH | First generation insulin analogues (detemir, NPH and glargine-U100) vs second generation insulin analogues (degludec-U100, glargine-U300) |
Comparisons considered | Detemir vs NPH Glargine vs NPH Detemir vs Glargine Degludec vs Detemir Degludec vs Glargine | Detemir vs NPH: Detemir once daily vs NPH once daily Detemir once/twice daily vs NPH once/twice daily Detemir twice daily vs NPH twice daily Detemir vs Glargine-U100: Detemir twice daily vs Glargine once daily Detemir once/twice daily vs Glargine once daily Degludec-U100 once daily vs Glargine-U100 once daily: Degludec-U200 once daily vs Glargine-U300 once daily Degludec vs Glargine (concentration not defined) Degludec once daily vs Glargine twice daily Degludec once daily vs Glargine once daily Glargine-U100 vs NPH: Glargine-U100 once daily vs NPH four times daily Glargine-U100 once daily vs NPH once/twice daily Glargine-U100 once daily vs NPH twice daily Glargine-U100 once daily vs NPH twice or more daily Degludec-U100 once daily vs Detemir once daily Glargine-U300 once daily vs Glargine-U100 once daily Glargine-U100 once daily vs Glargine-U100 twice daily Detemir once daily vs Detemir twice daily: | : |
Inclusion criteria | Included studies on children and subsequently also performed subgroup analyses on studies that included adults Only included studies > 24 weeks in length Included unpublished data (subgroup analysis also performed) | Excluded studies in which participants were younger than 18 Included studies of any duration | Only included adults Excluded studies if < 12 weeks duration. Main analysis reported > 24 weeks (main analysis), > 12 weeks reported as sensitivity analysis Had to report on at least one of the following: HbA1c, weight change, severe hypoglycaemia (event requiring assistance), nocturnal severe hypoglycaemia severe hypoglycaemia occurring at night defined at 23:00–06:00), confirmed hypoglycaemia (< 3 mmol/L), nocturnal confirmed hypoglycaemia Excluded participants with recurrent severe hypoglycaemia • Excluded if pregnant, child or breastfeeding |
Primary trial outcomes | All-cause mortality Health-related quality of life Severe hypoglycaemia Non-fatal myocardial infarction/stroke Severe nocturnal hypoglycaemia Serious adverse events HbA1c | HbA1c Nocturnal hypoglycaemia Severe hypoglycaemia DKA Time in target glucose range Time spent in hypoglycaemic range Quality of life including patient satisfaction Adverse events o Cancer o Injection site issues o Weight gain/loss o Hospital admissions o Frequency of hospitalization related to diabetes o Ambulance call-outs o Mental health outcomes (daily burden, fear of hypoglycaemia, treatment burden, diabetes burnout) | Efficacy: HbA1c Safety: Confirmed hypoglycaemia Confirmed nocturnal hypoglycaemia Severe hypoglycaemia Nocturnal severe hypoglycaemia Change in body weight |