OBJECTIVES

Although insulin glargine is commonly prescribed for the management of diabetes mellitus, there is uncertainty regarding its advantages when compared with conventional insulins. The aim of the present meta-analysis is the assessment of differences with respect to HbA1c reduction, incidence of hypoglycemia, and weight gain, between NPH human insulin and insulin glargine in adults with Type 2 diabetes.

METHODS

A systematic review was conducted in major databases including PubMed, Cochrane, Embase, Google scholar, and Web of Science up to March 2020 with limitation to English full-text published articles. Data on study design, participants, glycated hemoglobin (HbA1c), body weight and hypoglycemia were independently abstracted by two investigators using a standardized protocol. Meta-analysis was performed using RevMan 5.3 software.

RESULTS

Data from a total of 6127 participants in 20 RCTs were pooled using a random‐effects model. Most of the studies were of short to medium duration and of low to medium quality. The standardized mean difference for HbA1c and body weight for patients treated with glargine as compared with NPH was -0.07% (-0.12 to -0.01) and 0.13kg (-0.09 to -0.34), respectively. More participants experienced symptomatic, severe, and nocturnal hypoglycemia on NPH than glargine (OR: -0.26, -0.34, -0.62, respectively). No significant difference was found in terms of mean daily dose consumption of glargine versus NPH.

CONCLUSIONS

There is a significant difference in HbA1c reduction and weight gain in favor of glargine compared with NPH insulin. The differences was found to be marginal, but significant. In addition, less patients experienced symptomatic, severe, or nocturnal hypoglycemia with glargine in adults with Type 2 diabetes.