Nørgaard, Kirsten, Sukumar, Nithya, Rafnsson, Snorri B and Saravanan, Ponnusamy (2018) Efficacy and safety of rapid-acting insulin analogs in special populations with type 1 diabetes or gestational diabetes : Systematic Review and Meta-Analysis. Diabetes therapy, 9 (3). pp. 891-917. doi:10.1007/s13300-018-0411-7 ISSN 1869-6961.

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Abstract

To assess the efficacy and safety of three available rapid-acting insulin analogs (insulins lispro, aspart and glulisine, respectively) in pregnant women, children/adolescents and people using continuous subcutaneous insulin infusion (CSII) with type 1 diabetes. PubMed, EMBASE and Cochrane Reviews were searched electronically, and their bibliographies examined to identify suitable studies for review and inclusion in a meta-analysis. Eligible studies were randomized controlled trials that reported data on relevant clinical outcomes. A different reviewer abstracted data for each of the three subpopulations, and one reviewer abstracted data for all three. Any differences were resolved by consensus or by consulting a fourth reviewer. In people on CSII, rapid-acting insulin analogs lowered postprandial plasma glucose post-breakfast to a greater extent than did regular human insulin (RHI) (mean difference: - 1.63 mmol/L [95% confidence interval - 1.71; - 1.54]), with a comparable risk of hypoglycemia and a trend for lower glycated hemoglobin. In the pediatric population, glycemic control was similar with rapid-acting insulin analogs and RHI, with no safety concerns. Meta-analysis indicated severe hypoglycemic events were comparable for rapid-acting insulin analogs versus RHI (risk difference: 0.00 [95% confidence interval - 0.01; 0.01]). In the pregnancy group, insulin lispro and insulin aspart were safe and effective for both mother and fetus, with glycemic control being at least as good as with RHI. There were no data on insulin glulisine during pregnancy. Rapid-acting insulin analogs appear generally safe and effective in these special populations; however, additional trials would be helpful.

Item Type:	Journal Article
Subjects:	Q Science > QP Physiology R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
SWORD Depositor:	Library Publications Router
Library of Congress Subject Headings (LCSH):	Diabetes in pregnancy -- Treatment, Diabetes, Insulin -- Derivatives
Journal or Publication Title:	Diabetes therapy
Publisher:	Springer Healthcare Communications Ltd.
ISSN:	1869-6961
Official Date:	June 2018
Dates:	Date Event June 2018 Published 5 April 2018 Available 14 March 2018 Accepted
Volume:	9
Number:	3
Page Range:	pp. 891-917
DOI:	10.1007/s13300-018-0411-7
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	5 June 2018
Date of first compliant Open Access:	6 June 2018
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID UNSPECIFIED Novo Nordisk http://dx.doi.org/10.13039/501100004191

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