Comparison of effectiveness of premixed insulin with long-acting insulin in diabetes: evidence from real-world cohort studies—systematic review and meta-analyses

  • Ziping Ye
  • Qian Xin
  • Xiaotong Jiang
  • Lihua Sun
Review Article


The purpose of this research is to perform a systematic review and meta-analysis to compare effectiveness of premixed insulin (PM) and long-acting insulin (LA) based on cohort studies. Embase, Pubmed, Web of Science,, and Opengray were searched. We included all cohort studies comparing the effectiveness of PM with LA on intermediate- or long-term outcomes. The weighted mean difference (WMD) was recorded for intermediate outcomes, and the risk ratio (RR) estimates were combined and weighted to produce pooled RR for long-term outcomes. Subgroup analysis was conducted by different insulin type and population. Eight studies involving 95,415 patients were included, in which six studies were used for quantitative analysis. Follow-up duration ranged from 6 months to 5 years. The meta-analysis indicated a comparable effect of PM and LA on the mean reduction in hemoglobin A1c (HbA1c) (WMD = − 0.03% [95% CI − 0.12–0.07]). Less fasting plasma glucose (FPG) declines were noticed with PM than LA (0.11 mmol/L [95% CI 0.03–0.18]). There was not statistically significant difference for post-prandial glucose (WMD = − 0.61 mmol/L [95% CI [− 1.49–0.27]). PM was associated with further weight gain of 0.67 kg [95% CI 0.60–0.74] and more insulin consumption (WMD = 11.72 U/day [95% CI 8.02–15.43]. The rates of hypoglycemia events were low but varied considerably. There was no significant difference in the effectiveness of PM and LA in real-world setting on HbA1c reduction, although PM was related with less FPG reductions, slight weight gain, and more insulin consumptions. Future real-world studies should concern about balanced oral hypoglycemic agents regimens between insulin cohorts and other potential confounding factors and assess relevant complications and death rate.


Effectiveness Premixed insulin Long-acting insulin Cohort studies Systematic review Meta-analyses 



There are no acknowledgments or funding source for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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

Supplementary material

13410_2018_621_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 17 kb)


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Copyright information

© Research Society for Study of Diabetes in India 2018

Authors and Affiliations

  • Ziping Ye
    • 1
  • Qian Xin
    • 1
  • Xiaotong Jiang
    • 1
  • Lihua Sun
    • 1
  1. 1.College of business administrationShenyang Pharmaceutical UniversityShenyangChina

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