Statement 2
NPH insulin is not as effective as analogue insulin in HbA1c reduction,
causes more frequent and severe hypoglycaemia, and causes more
weight gain in those diagnosed with Type 2 diabetes.
Glycaemic control
A systematic review found no difference in HbA1c level between insulin glargine and NPH insulin,
and only a small non-significant difference in trials of insulin detemir versus NPH insulin (HbA1c
level was higher with insulin detemir by 0.08%; 95% CI –0.03 to 0.19). Overall, the systematic
review concluded that “insulin glargine and insulin detemir are equivalent to NPH in terms of
glycaemic control as reflected in HbA1c level”13.
Hypoglycaemia
No differences in the frequency of severe hypoglycaemia between the insulin analogues and
NPH insulin were found, but, overall hypoglycaemia was less frequent with both insulin glargine
(OR 0.74, 95% CI 0.63 to 0.89) and insulin detemir (OR 0.51, 95% CI 0.35 to 0.76). The systematic
review concluded that insulin analogues have modest advantages in terms of hypoglycaemia,
especially nocturnal13.
Weight
Insulin therapy is likely to increase body weight by 2-4kg on average and usually greatest during
early stages of insulin use14. Strategies to minimise weight gain should be discussed at insulin
initiation and periodically throughout therapy to minimise weight gain. Weight gain in patients
on insulin glargine was slightly less than in patients on NPH insulin (0.28 kg; 95% CI –0.72 to 0.15)
but this was neither clinically nor statistically significant. On insulin detemir, the difference was a
little greater (1.2 kg; 95% CI –1.6 to –0.8) but again unlikely to be clinically significant13.
Summary
The systematic review did not identify any robust data on the effect of long-acting analogues
on outcomes such as mortality, morbidity or quality of life13.
In the absence of evidence to suggest the superiority of insulin analogues over NPH insulin with
respect to improved safety, glycaemic control or reduction of long-term diabetic complications,
a cautious approach to their prescribing is advised15.
Statement 3
NPH insulin is not as effective as insulin degludec in HbA1c reduction,
causes more frequent and severe hypoglycaemia, and causes more
weight gain in those diagnosed with Type 2 diabetes.
No published studies were identified comparing insulin degludec (long-acting insulin analogue)
with NPH insulin and no studies were identified that measured patient orientated efficacy
outcomes16.
Statement 4
Analogue insulin works better than NPH insulin in certain ethnic
backgrounds.
No published studies were identified that evaluated the efficacy or safety of insulins on the
basis of ethnicity
NPH insulin is not as effective as analogue insulin in HbA1c reduction,
causes more frequent and severe hypoglycaemia, and causes more
weight gain in those diagnosed with Type 2 diabetes.
Glycaemic control
A systematic review found no difference in HbA1c level between insulin glargine and NPH insulin,
and only a small non-significant difference in trials of insulin detemir versus NPH insulin (HbA1c
level was higher with insulin detemir by 0.08%; 95% CI –0.03 to 0.19). Overall, the systematic
review concluded that “insulin glargine and insulin detemir are equivalent to NPH in terms of
glycaemic control as reflected in HbA1c level”13.
Hypoglycaemia
No differences in the frequency of severe hypoglycaemia between the insulin analogues and
NPH insulin were found, but, overall hypoglycaemia was less frequent with both insulin glargine
(OR 0.74, 95% CI 0.63 to 0.89) and insulin detemir (OR 0.51, 95% CI 0.35 to 0.76). The systematic
review concluded that insulin analogues have modest advantages in terms of hypoglycaemia,
especially nocturnal13.
Weight
Insulin therapy is likely to increase body weight by 2-4kg on average and usually greatest during
early stages of insulin use14. Strategies to minimise weight gain should be discussed at insulin
initiation and periodically throughout therapy to minimise weight gain. Weight gain in patients
on insulin glargine was slightly less than in patients on NPH insulin (0.28 kg; 95% CI –0.72 to 0.15)
but this was neither clinically nor statistically significant. On insulin detemir, the difference was a
little greater (1.2 kg; 95% CI –1.6 to –0.8) but again unlikely to be clinically significant13.
Summary
The systematic review did not identify any robust data on the effect of long-acting analogues
on outcomes such as mortality, morbidity or quality of life13.
In the absence of evidence to suggest the superiority of insulin analogues over NPH insulin with
respect to improved safety, glycaemic control or reduction of long-term diabetic complications,
a cautious approach to their prescribing is advised15.
Statement 3
NPH insulin is not as effective as insulin degludec in HbA1c reduction,
causes more frequent and severe hypoglycaemia, and causes more
weight gain in those diagnosed with Type 2 diabetes.
No published studies were identified comparing insulin degludec (long-acting insulin analogue)
with NPH insulin and no studies were identified that measured patient orientated efficacy
outcomes16.
Statement 4
Analogue insulin works better than NPH insulin in certain ethnic
backgrounds.
No published studies were identified that evaluated the efficacy or safety of insulins on the
basis of ethnicity
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