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Effectiveness of insulin glargine U-300 versus insulin glargine U-100 on nocturnal hypoglycemia and glycemic control in type 1 and type 2 diabetes: a systematic review and meta-analysis

  • Ana Díez-Fernández
  • Iván Cavero-Redondo
  • Jesús Moreno-Fernández
  • Diana P. Pozuelo-Carrascosa
  • Miriam Garrido-Miguel
  • Vicente Martínez-Vizcaíno
Original Article

Abstract

Aims

To assess the effectiveness of insulin glargine 300 ui/ml (Gla-300) compared with insulin glargine 100 ui/ml (Gla-100) on reducing nocturnal hypoglycemia and improving glycemic control in type 1 and type 2 diabetes patients.

Methods

We systematically searched in Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials until July 4th, 2018. This study was registered with PROSPERO (CRD42017080134). We included randomized clinical trials comparing Gla-300 versus Gla-100 reporting the rate ratio or number of events of nocturnal hypoglycemia and HbA1c levels percentage or mmol/mol−1. The main outcome was the incidence rate ratio (RR) of nocturnal hypoglycemia events. The heterogeneity of results across studies was assessed using the I2 statistic. Fixed- and random-effect models were used to estimate pooled RRs.

Results

Nine studies were included in the meta-analysis, including 3977 adult patients. Compared with Gla-100, the use of Gla-300 reduced confirmed nocturnal hypoglycemia [RR = 0.81 (0.69, 0.95)] and clinically significant nocturnal hypoglycemia [RR = 0.75 (0.63, 0.91)]. Reductions in clinically significant nocturnal hypoglycemia events [RR = 0.64 (0.42, 0.97)] in type 1 diabetes patients were found. A small decrease in HbA1c levels in favor of Gla-300 in the pooled sample was identified [ES = − 0.08 (95% CI − 0.14, − 0.01)].

Conclusions

The best current evidence indicates that Gla-300 reduces the incidence of nocturnal hypoglycemia with slight improvements in glycemic control compared with Gla-100 in both type 1 and type 2 diabetes adult patients.

Keywords

Type 2 diabetes Type 1 diabetes Insulin glargine Hypoglycemia HbA1c; meta-analysis 

Notes

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

AD-F declares that she has no conflict of interest. IC-R declares that he has no conflict of interest. JM-F declares that he has no conflict of interest. DP-C declares that she has no conflict of interest. MG-M declares that she has no conflict of interest. VM-V declares that he has no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

592_2018_1258_MOESM1_ESM.docx (595 kb)
Supplementary material 1 (DOCX 595 KB)

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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  • Ana Díez-Fernández
    • 1
    • 2
  • Iván Cavero-Redondo
    • 1
  • Jesús Moreno-Fernández
    • 3
  • Diana P. Pozuelo-Carrascosa
    • 1
  • Miriam Garrido-Miguel
    • 1
  • Vicente Martínez-Vizcaíno
    • 1
    • 4
  1. 1.Health and Social Research CentreUniversidad de Castilla-La ManchaCuencaSpain
  2. 2.Faculty of NursingUniversidad de Castilla-La ManchaCuencaSpain
  3. 3.Department of Endocrinology and NutritionCiudad Real General University HospitalCiudad RealSpain
  4. 4.Faculty of Health SciencesAutonomous University of ChileTalcaChile

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