Aims: To investigate the effectiveness, safety, optimal starting dose, optimal maintenance dose range, and target fasting plasma glucose of five basal insulins in insulin-naïve patients with type 2 diabetes mellitus.
Methods: MEDLINE, EMBASE, Web of Science, and the Cochrane Library were searched from January 2000 to February 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was adopted. The registration ID is CRD42022319078 in PROSPERO.
Results: Among 11 163 citations retrieved, 35 publications met the planned criteria. From meta-analyses and network meta-analyses, we found that when injecting basal insulin regimens at bedtime, the optimal choice in order of most to least effective might be glargine U-300 or degludec U-100, glargine U-100 or detemir, followed by neutral protamine hagedorn (NPH). Injecting glargine U-100 in the morning may be more effective (ie, more patients archiving glycated hemoglobin < 7.0%) and lead to fewer hypoglycemic events than injecting it at bedtime. The optimal starting dose for the initiation of any basal insulins can be 0.10-0.20 U/kg/day. There is no eligible evidence to investigate the optimal maintenance dose for basal insulins.
Conclusions: The five basal insulins are effective for the target population. Glargine U-300, degludec U-100, glargine U-100, and detemir lead to fewer hypoglycemic events than NPH without compromising glycemic control.
目的:探讨5种基础胰岛素治疗在尚未接受胰岛素治疗的2型糖尿病(T2DM)患者的有效性、安全性、最佳起始剂量、最佳维持剂量范围及空腹血糖目标。 方法:检索2000年1月至2022年2月MEDLINE、EMBASE、Web of Science、Cochrane Library等数据库。遵循系统综述和meta分析的首选报告项目(PRISMA)指南并采用建议、评估、发展和评价的分级(GRADE)方法。在PROSPERO的注册ID为CRD42022319078。 结果:共检索到文献11163篇, 符合纳入标准的文献35篇。从meta分析和网络meta分析中, 我们发现, 在睡前注射基础胰岛素方案时, 最优选择可能是甘精胰岛素U-300或德谷胰岛素U-100、甘精胰岛素U-100或地特胰岛素, 其次是低精蛋白锌胰岛素(NPH)。与睡前注射相比, 早晨注射甘精胰岛素U-100可能更有效(即更多患者能够实现HbA1c <7.0%), 且低血糖事件更少。任何基础胰岛素起始的最佳起始剂量可为0.10-0.20 U/kg/天。没有合适的证据来研究基础胰岛素的最佳维持剂量。 结论:5种基础胰岛素对目标人群有效。与NPH相比, 甘精胰岛素U-300、德谷胰岛素U-100、甘精胰岛素U-100和地特胰岛素在不影响血糖控制的情况下可减少低血糖事件。.
Keywords: 2型糖尿病; basal insulin; effectiveness; initiation and maintenance dose; safety; systematic review; type 2 diabetes; 基础胰岛素; 安全; 有效性; 系统评价; 起始和维持剂量.
© 2023 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.