title: Basal supplementation of insulin lispro protamine suspension versus insulin glargine and detemir for type 2 diabetes: meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  We compared the effect of insulin lispro protamine suspension (ILPS) with that of insulin glargine and insulin detemir, all given as basal supplementation, in the treatment of patients with type 2 diabetes.
  
  
  METHODS
  We conducted an electronic search until February 2012, including online registries of ongoing trials and abstract books. All randomized controlled trials comparing ILPS with insulin glargine or detemir with a duration of ≥12 weeks were included.
  
  
  RESULTS
  We found four trials lasting 24-36 weeks involving 1,336 persons: three studies compared ILPS with glargine, and one trial compared ILPS with detemir. There was no significant difference in change in HbA(1c) level between ILPS and comparators, in the proportion of patients achieving the HbA(1c) goals of ≤6.5 or <7%, in weight change, or in daily insulin doses. There was no difference in overall hypoglycemia, but nocturnal hypoglycemia occurred significantly more with ILPS than with comparator insulins (mean difference 0.099 events/patient/30 days [95% CI 0.03-0.17]). In a prespecified sensitivity analysis comparing data obtained in patients who remained on their once-daily insulin regimen, not significantly different event rates for nocturnal hypoglycemia were observed between ILPS and comparator insulins (0.063 [-0.007 to 0.13]), and ILPS was associated with lower insulin dose (0.07 units/kg/day [0.05-0.09]).
  
  
  CONCLUSIONS
  There is no difference between ILPS and insulin glargine or detemir for targeting hyperglycemia, but nocturnal hypoglycemia occurred more frequently with ILPS than with comparator insulins. Nocturnal hypoglycemia was not significantly different in people who injected insulin once daily.
authors.affiliation: Department of Cardio-Thoracic and Respiratory Sciences, Second University of Naples, Naples, Italy. katherine.esposito@unina2.it
authors.forename: Katherine
authors.initials: K
authors.lastname: Esposito
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiodini
authors.forename: Annalisa
authors.initials: A
authors.lastname: Capuano
authors.forename: Michela
authors.initials: M
authors.lastname: Petrizzo
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Improta
authors.forename: Dario
authors.initials: D
authors.lastname: Giugliano
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D061268:Insulin Lispro / Q000627:therapeutic use*; D049528:Insulin, Long-Acting / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
chemical_list: D007004:Hypoglycemic Agents; D061268:Insulin Lispro; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine; D000069057:Insulin Detemir