title: Comparative efficacy and safety of insulin analogs in hospitalized adults.
abstract: OBJECTIVE
  The comparative efficacy, safety, and cost-effectiveness of rapid and long-acting insulin analogs compared with regular or neutral protamine Hagedorn nonanalog insulins or with oral antidiabetic agents in hospitalized adults were evaluated.
  
  
  METHODS
  A literature search was conducted to identify studies that compared the effects of rapid-acting, long-acting, or mixed insulin analogs with short- or intermediate-acting insulin or any other oral antidiabetic medication.
  
  
  RESULTS
  Twenty-three primary studies were included in the review. Rapid-acting analogs and basal-bolus analog regimens were found to reduce the duration of hospital stay by approximately one day compared with regular insulin and basal-bolus nonanalog regimens. One large cohort study found an adjusted 48% relative risk reduction in mortality with rapid-acting analogs versus regular insulin in a heterogeneous hospitalized hyperglycemic population. A randomized controlled trial found a significant reduction in postoperative complications with basal-bolus analogs compared with basal-bolus nonanalog insulin. When compared with regular sliding-scale insulin (SSI), fixed-dose insulin glargine with or without insulin glulisine was found to reduce the blood glucose concentration in patients with type 2 diabetes and reduce postoperative complications in surgical patients with diabetes. The quality of evidence was primarily very low or low for most outcomes.
  
  
  CONCLUSIONS
  A systematic literature review revealed a very low or low quality of evidence, suggesting that, compared with nonanalog regimens, rapid-acting insulin analogs reduce the duration of hospital stay and mortality rates and that basal- bolus analog regimens may reduce the duration of hospital stay and postoperative complications. There is also a low quality of evidence to suggest that a fixed-dose analog regimen of insulin glargine with or without insulin glulisine is more effective than regular SSI for reducing blood glucose concentrations and postoperative complications.
authors: Kavita Singh, B.Sc.Phm., M.P.H., is Ph.D. Student, University of Ottawa, Ontario, Canada. Mohammed T. Ansari, M.B.B.S., M.Med. Sc., M.Phil., is Associate Investigator, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, and Adjunct Professor, Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa. Rakesh V. Patel, M.D. Pharm.D., is Director, Adult Critical Care Medicine Training Program, University of Ottawa, and Staff Intensivist, The Ottawa Hospital. Mario Bedard, B.Pharm., Pharm.D., is Director of Pharmacy, The Ottawa Hospital, Ottawa. Erin Keely, M.D., FRCPC, is Chief, Division of Endocrinology and Metabolism, The Ottawa Hospital, and Professor, Departments of Medicine and Obstetrics/Gynecology, University of Ottawa. Mike Tierney, B.Sc.Phm., M.Sc., is Vice President, Clinical Programs, The Ottawa Hospital. David Moher, Ph.D., is Senior Scientist, Ottawa Hospital Research Institute. kavita.singh@alumni.utoronto.ca.
authors: Kavita
authors: K
authors: Singh
authors: Kavita Singh, B.Sc.Phm., M.P.H., is Ph.D. Student, University of Ottawa, Ontario, Canada. Mohammed T. Ansari, M.B.B.S., M.Med. Sc., M.Phil., is Associate Investigator, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, and Adjunct Professor, Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa. Rakesh V. Patel, M.D. Pharm.D., is Director, Adult Critical Care Medicine Training Program, University of Ottawa, and Staff Intensivist, The Ottawa Hospital. Mario Bedard, B.Pharm., Pharm.D., is Director of Pharmacy, The Ottawa Hospital, Ottawa. Erin Keely, M.D., FRCPC, is Chief, Division of Endocrinology and Metabolism, The Ottawa Hospital, and Professor, Departments of Medicine and Obstetrics/Gynecology, University of Ottawa. Mike Tierney, B.Sc.Phm., M.Sc., is Vice President, Clinical Programs, The Ottawa Hospital. David Moher, Ph.D., is Senior Scientist, Ottawa Hospital Research Institute.
authors: Mohammed T
authors: MT
authors: Ansari
authors: Kavita Singh, B.Sc.Phm., M.P.H., is Ph.D. Student, University of Ottawa, Ontario, Canada. Mohammed T. Ansari, M.B.B.S., M.Med. Sc., M.Phil., is Associate Investigator, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, and Adjunct Professor, Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa. Rakesh V. Patel, M.D. Pharm.D., is Director, Adult Critical Care Medicine Training Program, University of Ottawa, and Staff Intensivist, The Ottawa Hospital. Mario Bedard, B.Pharm., Pharm.D., is Director of Pharmacy, The Ottawa Hospital, Ottawa. Erin Keely, M.D., FRCPC, is Chief, Division of Endocrinology and Metabolism, The Ottawa Hospital, and Professor, Departments of Medicine and Obstetrics/Gynecology, University of Ottawa. Mike Tierney, B.Sc.Phm., M.Sc., is Vice President, Clinical Programs, The Ottawa Hospital. David Moher, Ph.D., is Senior Scientist, Ottawa Hospital Research Institute.
authors: Rakesh V
authors: RV
authors: Patel
authors: Kavita Singh, B.Sc.Phm., M.P.H., is Ph.D. Student, University of Ottawa, Ontario, Canada. Mohammed T. Ansari, M.B.B.S., M.Med. Sc., M.Phil., is Associate Investigator, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, and Adjunct Professor, Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa. Rakesh V. Patel, M.D. Pharm.D., is Director, Adult Critical Care Medicine Training Program, University of Ottawa, and Staff Intensivist, The Ottawa Hospital. Mario Bedard, B.Pharm., Pharm.D., is Director of Pharmacy, The Ottawa Hospital, Ottawa. Erin Keely, M.D., FRCPC, is Chief, Division of Endocrinology and Metabolism, The Ottawa Hospital, and Professor, Departments of Medicine and Obstetrics/Gynecology, University of Ottawa. Mike Tierney, B.Sc.Phm., M.Sc., is Vice President, Clinical Programs, The Ottawa Hospital. David Moher, Ph.D., is Senior Scientist, Ottawa Hospital Research Institute.
authors: Mario
authors: M
authors: Bedard
authors: Kavita Singh, B.Sc.Phm., M.P.H., is Ph.D. Student, University of Ottawa, Ontario, Canada. Mohammed T. Ansari, M.B.B.S., M.Med. Sc., M.Phil., is Associate Investigator, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, and Adjunct Professor, Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa. Rakesh V. Patel, M.D. Pharm.D., is Director, Adult Critical Care Medicine Training Program, University of Ottawa, and Staff Intensivist, The Ottawa Hospital. Mario Bedard, B.Pharm., Pharm.D., is Director of Pharmacy, The Ottawa Hospital, Ottawa. Erin Keely, M.D., FRCPC, is Chief, Division of Endocrinology and Metabolism, The Ottawa Hospital, and Professor, Departments of Medicine and Obstetrics/Gynecology, University of Ottawa. Mike Tierney, B.Sc.Phm., M.Sc., is Vice President, Clinical Programs, The Ottawa Hospital. David Moher, Ph.D., is Senior Scientist, Ottawa Hospital Research Institute.
authors: Erin
authors: E
authors: Keely
authors: Kavita Singh, B.Sc.Phm., M.P.H., is Ph.D. Student, University of Ottawa, Ontario, Canada. Mohammed T. Ansari, M.B.B.S., M.Med. Sc., M.Phil., is Associate Investigator, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, and Adjunct Professor, Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa. Rakesh V. Patel, M.D. Pharm.D., is Director, Adult Critical Care Medicine Training Program, University of Ottawa, and Staff Intensivist, The Ottawa Hospital. Mario Bedard, B.Pharm., Pharm.D., is Director of Pharmacy, The Ottawa Hospital, Ottawa. Erin Keely, M.D., FRCPC, is Chief, Division of Endocrinology and Metabolism, The Ottawa Hospital, and Professor, Departments of Medicine and Obstetrics/Gynecology, University of Ottawa. Mike Tierney, B.Sc.Phm., M.Sc., is Vice President, Clinical Programs, The Ottawa Hospital. David Moher, Ph.D., is Senior Scientist, Ottawa Hospital Research Institute.
authors: Mike
authors: M
authors: Tierney
authors: Kavita Singh, B.Sc.Phm., M.P.H., is Ph.D. Student, University of Ottawa, Ontario, Canada. Mohammed T. Ansari, M.B.B.S., M.Med. Sc., M.Phil., is Associate Investigator, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, and Adjunct Professor, Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa. Rakesh V. Patel, M.D. Pharm.D., is Director, Adult Critical Care Medicine Training Program, University of Ottawa, and Staff Intensivist, The Ottawa Hospital. Mario Bedard, B.Pharm., Pharm.D., is Director of Pharmacy, The Ottawa Hospital, Ottawa. Erin Keely, M.D., FRCPC, is Chief, Division of Endocrinology and Metabolism, The Ottawa Hospital, and Professor, Departments of Medicine and Obstetrics/Gynecology, University of Ottawa. Mike Tierney, B.Sc.Phm., M.Sc., is Vice President, Clinical Programs, The Ottawa Hospital. David Moher, Ph.D., is Senior Scientist, Ottawa Hospital Research Institute.
authors: David
authors: D
authors: Moher
mesh_terms: D003362:Cost-Benefit Analysis; D006760:Hospitalization; D006801:Humans; D007328:Insulin / Q000009:adverse effects* / Q000031:analogs & derivatives / Q000627:therapeutic use*
chemical_list: D007328:Insulin