We conducted a systematic review of randomized controlled trials (RCTs) that evaluated the effectiveness of insulin regimens with insulin analogs to reach the glycosylated hemoglobin (HbA1c) target of <7% in patients with type 2 diabetes.
Methods:
RCTs involving insulin regimens (basal, prandial, biphasic, and basal-bolus) with insulin analogs in type 2 diabetes were identified through electronic searches [MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and The Cochrane Library] through September, 2010. We included any study arm of RCTs if they were at least 12 weeks in duration and reported HbA1c as an outcome.
Results:
We identified 55 RCTs, with 96 arms and 33,244 patients, that reported the HbA1c target, and 32 RCTs, with 32 arms and 5,559 patients, that did not report the target. The missing targets were calculated with an algorithm that explained 88% of variability between studies. Overall, the proportion of patients at target (HbA1c <7%) was 37.2% [95% confidence interval (CI), 31.5–43.1%] with basal insulin, 35.3% (28.9–42.1%) with biphasic insulin, 37.5% (27.7–47.9%) with prandial insulin, and 51.2% (41.4–61.1%) for basal-bolus insulin, with high heterogeneity (I2 >80% for all).
Conclusions:
The HbA1c target <7% can be achieved in a proportion of patients ranging from 35% to 51%, depending on the particular insulin regimen. At least one half of patients with type 2 diabetes receiving insulin analogs do not reach the HbA1c target.
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