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- Title
Hypoglycemia and Glycemic Control in Type 2 Diabetes: a Meta-Analysis of Six Randomized Controlled Trials Comparing Insulin NPH with Insulin Glargine.
- Authors
Mullins, Peter; Jarvinen, Hannele Yki; Sharplin, Peter A.; Riddle, Matthew
- Abstract
Patient-level data from six randomized clinical trials comparing insulin NPH and insulin glargine, including 3,175 patients diagnosed with type 2 diabetes, were used to evaluate the relationship between hypoglycemia and HbA1c. The analysis uses a negative binomial regression which applies because the data on hypoglycemia do not conform to usual statistical assumptions about normality, and because regression allows for HbA1c change to be modeled as a covariate. All included studies were of randomized parallel group design and of a minimum of six months duration. For any given level of HbA1c, hypoglycemic event rates were lower with glargine than with NPH: 6.9% lower p=ns) for all symptomatic hypoglycemic events; 32.0% lower (p<0.05) for hypoglycemic events confirmed by glucose ≤ 3.6 mmol/L, 32.5% lower (p<0.01) for nocturnal events, and 50.9% (p<0.05) for severe hypoglycemia. In general, the reductions are larger than those published in the individual studies, which use less sophisticated statistical methods. These results confirm the superiority of insulin glargine over insulin NPH with regard to risk of hypoglycemia for a set level of glycemic control, and show that this advantage for type 2 diabetes may have been underestimated by analyses of individual studies. Additionally, a significant between-treatment difference favoring glargine is confirmed for severe hypoglycemic events.
- Subjects
HYPOGLYCEMIA; BLOOD sugar monitoring; TYPE 2 diabetes; INSULIN therapy; HYPOGLYCEMIC agents
- Publication
Diabetes, 2007, Vol 56, pA160
- ISSN
0012-1797
- Publication type
Article