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Long-acting insulin analogues—are benefits worth the cost?

Controlled clinical trials have demonstrated a substantial reduction in all long-term complications of type 1 diabetes mellitus (T1DM) if an HbA1c level of <7% is achieved. Long-acting insulin analogues have now been developed; however, their role in the intensive therapy of patients with T1DM is debatable.

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  1. Hirsch, I. B. et al. Insulin degludec/insulin aspart administered once daily at any meal, with insulin aspart at other meals versus a standard basal-bolus regimen in patients with type 1 diabetes: a 26-week phase 3, randomized, open-label, treat-to-target trial. Diabetes Care

  2. Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N. Engl. J. Med. 329, 977–986 (1993).

  3. DCCT/EDIC Research Group et al. Intensive diabetes therapy and glomerular filtration rate in type 1 diabetes. N. Engl. J. Med. 365, 2366–2376 (2011).

  4. Nathan, D. M. et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes mellitus. N. Engl. J. Med. 353, 2643–2653 (2005).

    Article  Google Scholar 

  5. Birkeland, K. I. et al. Insulin degludec in type 1 diabetes: a randomized controlled trial of a new-generation ultra-long-acting insulin compared with insulin glargine. Diabetes Care 34, 661–665 (2011).

    Article  Google Scholar 

  6. Heller, S. et al. Insulin degludec, an ultra-long acting basal insulin, versus insulin glargine in basal-bolus treatment with mealtime insulin aspart in type 1 diabetes (BEGIN Basal-Bolus Type 1): a phase 3, randomised, open-label, treat-to-target non-inferiority trial. Lancet 379, 1489–1497 (2012).

    Article  CAS  Google Scholar 

  7. Le-Floch, J.-P. et al. Comparison of once- versus twice-daily administration of insulin detemir, used with mealtime insulin aspart, in basal-bolus therapy for type 1 diabetes. Diabetes Care 32, 32–37 (2009).

    Article  CAS  Google Scholar 

  8. Deeb, L. C., Tan, M. H. & Alberti, K. G. Insulin availability among International Diabetes Federation member associations. Report of the Task Force on Insulin Distribution. Diabetes Care 17, 220–223 (1994).

    Article  CAS  Google Scholar 

  9. Monami, M., Marchionni, N. & Mannucci, E. Long-acting insulin analogues vs. NPH human insulin in type 1 diabetes. A meta-analysis. Diabetes Obes. Metab. 11, 372–378 (2009).

    Article  CAS  Google Scholar 

  10. Sanches, A. C., Correr, C. J., Venson, R. & Pontarolo, R. Revisiting the efficacy of long-acting insulin analogues on adults with type 1 diabetes using mixed-treatment comparisons. Diabetes Res. Clin. Pract. 94, 333–339 (2011).

    Article  CAS  Google Scholar 

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Nathan, D. Long-acting insulin analogues—are benefits worth the cost?. Nat Rev Endocrinol 8, 699–700 (2012).

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