Título :	Long-acting insulin analogues for type 1 diabetes : an overview of systematic reviews and meta-analysis of randomized controlled trials
Autor :	Laranjeira, Fernanda de Oliveira Andrade, Keitty Regina Cordeiro de Figueiredo, Ana Claudia Morais Godoy Silva, Silva, Everton Nunes da Pereira, Maurício Gomes
Assunto::	Diabetes Insulina
Fecha de publicación :	2018
Editorial :	Plos One
Abstract:	Background The comparison between long acting insulin analogues (LAIA) and human insulin (NPH) has been investigated for decades, with many randomized controlled trials (RCTs) and systematic reviews giving mixed results. This overlapping and contradictory evidence has increased uncertainty on coverage decisions at health systems level. Aim To conduct an overview of systematic reviews and update existing reviews, preparing new meta-analysis to determine whether LAIA are effective for T1D patients compared to NPH.Methods We identified systematic reviews of RCTs that evaluated the efficacy of LAIA glargine or detemir, compared to NPH insulin for T1D, assessing glycated hemoglobin (A1C) and hypoglycemia. Data sources included Pubmed, Cochrane Library, EMBASE and hand-searching. The methodological quality of studies was independently assessed by two reviewers, using AMSTAR and Jadad scale. We found 11 eligible systematic reviews that contained a total of 25 relevant clinical trials. Two reviewers independently abstracted data. Results We found evidence that LAIA are efficacious compared to NPH, with estimates showing a reduction in nocturnal hypoglycemia episodes (RR 0.66; 95% CI 0.57; 0.76) and A1C (95% CI 0.23; 0.12). No significance was found related to severe hypoglycemia (RR 0.94; 95% CI 0.71; 1.24). Conclusion This study design has allowed us to carry out the most comprehensive assessment of RCTs on this subject, filling a gap in diabetes research. Our paper addresses a question that is important not only for decision makers but also for clinicians.
metadata.dc.description.unidade:	Faculdade de Medicina (FMD)
metadata.dc.description2:	LARANJEIRA, Fernanda O. et al. Long-acting insulin analogues for type 1 diabetes: an overview of systematic reviews and meta-analysis of randomized controlled trials. PLoS ONE, v. 13, n. 4, e0194801. DOI: https://doi.org/10.1371/journal.pone.0194801. Disponível em: 04 jun. 2019.
Licença::	© 2018 Laranjeira et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
DOI:	https://doi.org/10.1371/journal.pone.0194801
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