COMMENTARY

Is One Basal Insulin Just Like Another?

Charles P. Vega, MD

Disclosures

August 15, 2018

Hello. I'm Dr Charles Vega, and I am a clinical professor of family medicine at the University of California at Irvine. Welcome to Medscape Morning Report, our 1-minute news story for primary care.

A new review concludes that basal insulin analogs used in patients with type 2 diabetes do not differ substantially in their glucose-lowering effect.

Conclusive evidence about the comparative efficacy of the many available basal insulins has been lacking. This meta-analysis and systematic review, based on 39 trials involving 10 basal insulin analogs, was meant to fill that gap.

The results of this review come with several important caveats. First, the overall quality of the evidence included in this analysis was determined to be low.

Second, the researchers noted concerns about bias, which affected almost half of the studies that looked at changes in A1c and nearly all studies that assessed hypoglycemia.

In addition, conclusions about the comparative effects of newer-generation long-acting basal insulin analogs were based mostly on indirect rather than head-to-head comparisons.

This adds to the worrisome problem of poor evidence underpinning the care of patients with type 2 diabetes requiring insulin. Another recently published study[1] concluded that basal insulin analogs were no better than the old—and far less expensive—NPH insulin.

Bottom line: Many patients with diabetes will need insulin sooner or later. The higher cost of some newer insulins may not be matched by their clinical performance.

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