Type 1 diabetes: Are long-acting insulin analogues better than human insulin?
There is no scientific proof that long-acting insulin analogues are better than long-acting human insulin. There is also a lack of long-term studies looking at the effects of using insulin analogues for many years.
People who have diabetes and have to inject insulin can choose between various types of insulin. Only a few people still use insulin that is extracted from pigs (porcine insulin). Nowadays, most people use genetically engineered human insulin, which has the same chemical structure as the insulin produced in the human body. Insulin analogues, which are also produced artificially, are another option. Their basic chemical structure has been changed. This makes some of the insulin analogues lower blood sugar levels faster and for a shorter amount of time than human insulin, while other insulin analogues have a longer lasting effect than human insulin.
Insulin products can be grouped into three main categories according to how long their effect lasts:
- intermediate-acting and
- long-acting Insulin.
Short-acting insulin is used to regulate sudden changes in blood sugar levels following meals. Intermediate-acting and long-acting insulin cover the basic insulin needs of the body, called the basal rate. Premixed combinations of different types of insulin are also available.
There are currently two long-acting insulin analogues on the German market: insulin glargine (“Lantus”) and insulin detemir (“Levemir”).
How do the different kinds of long-acting insulin compare?
Researchers at the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into whether long-acting insulin analogues have any advantages over long-acting human insulin in people with type 1 diabetes.Insulin analogues would have a benefit compared to human insulin if they were, for instance, better at preventing very low blood sugar, constant high blood sugar or complications caused by poorly controlled blood sugar levels. Insulin analogues would also offer an advantage if they made it easier for people to cope with diabetes in everyday life.
Research in children and adults
The researchers found twelve suitable studies involving about 4,300 adults. Insulin glargine was used in six of the studies, and insulin detemir was used in four of them. Two of the studies directly compared insulin glargine with insulin detemir. Treatment usually lasted between six and twelve months in these studies. One study (with insulin detemir) lasted more than two years.
The researchers also found five studies involving about 1,300 children and teenagers. Insulin glargine was used in two of the studies, and insulin detemir was used in three of them.
Some studies used human insulin as a treatment differently than is normally done and recommended in Germany: the participants did not always adjust the number of injections according to their individual insulin needs. This means that the results of these studies are not applicable to the normal treatment situation in Germany.
Long-acting insulin analogues: No known advantages or disadvantages
Complications and life expectancy: It was not possible for the IQWiG researchers to find out whether the various types of insulin influence complications and life expectancy differently. This is because there were no studies that observed participants over a number of years. The studies also did not provide any information about whether people who use insulin analogues need to go to hospital for treatment more or less often than people who use human insulin.
Hypoglycemia (very low blood sugar): All of the studies looked at how the different kinds of insulin affected people’s HbA1c levels and the frequency of hypoglycemia. HbA1c levels indicate how high your blood sugar has been over the last two to three months. Because low blood sugar increases the risk of hypoglycemia, the frequency of hypoglycemia was always considered together with the HbA1c data. It is important to know whether the people in the two treatment groups have similar blood sugar levels. Only then is it possible to assess whether the risk of hypoglycemia increased or decreased because of the treatment.
Overall, the studies did not produce any evidence that people who use insulin analogues were less likely to have hypoglycemia than people who use human insulin. One study in adults came to the conclusion that severe hypoglycemia was less common in patients who used insulin detemir compared to those who used human insulin, particularly at night. But because the people in the studies used insulin detemir in a way that is not recommended in Germany, these results are not applicable to the normal treatment situation in Germany. The frequency of mild hypoglycemia was similar for both kinds of insulin.
The two insulin analogues detemir and glargine were also directly compared with each other. The studies involved only adult participants. They used insulin detemir twice a day and insulin glargine once a day. These studies also showed no differences in the frequency of hypoglycemia.
Quality of life and satisfaction with treatment: Three studies looked at how the various kinds of insulin affected health-related quality of life in adults. But there were no noticeable differences. The type of insulin did not influence satisfaction with treatment either.
Body weight: People who used insulin detemir gained a bit less weight than people who used human insulin. This was about 0.7 kilograms on average in adults. Children and teenagers who used insulin detemir also put on a bit less weight. It is not known why insulin detemir was associated with less weight gain. So it is still not clear whether this is an advantage or disadvantage.
Side effects and discontinuation of treatment: The studies suggest that skin reactions at the site of injection in adults were more common in people who used insulin detemir than in those who used human insulin. Overall, people who used insulin analogues stopped their treatment just as often as people who used human insulin.
It is not possible to say how insulin analogues compare with human insulin in terms of how they affect life expectancy and possible complications of diabetes, and how safe they are over the long term. Long-term studies are needed to answer these questions.
Published by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany)
Next planned update: October 2016. You can find out more about how our health information is updated in our text "Informed Health Online: How our information is produced."
- October 23rd 2013 10:50
- September 07th 2010 15:41
IQWiG health information is based on research in the international literature. We identify the most scientifically reliable knowledge currently available, particularly what are known as “systematic reviews.” These summarize and analyze the results of scientific research on the benefits and harms of treatments and other health care interventions. This helps medical professionals and people who are affected by the medical condition to weigh up the pros and cons. You can read more about systematic reviews and why these can provide the most trustworthy evidence about the state of knowledge in our information “Evidence-based medicine.” We also have our health information reviewed to ensure medical and scientific accuracy.
Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Long-acting insulin analogues in the treatment of diabetes mellitus type 1. Final report; Commission A05-01. February 18, 2010 [Accessed on July 18, 2013] (Executive summary) (IQWiG reports; Volume 70 - in German).
In June 2013 we checked whether this information is still up-to-date. We did not find any recent research results that would have made it necessary to change the conclusions stated above.