Relationship of baseline HbA1c, HbA1c change, and HbA1c target of <7% with Insulin Analogues in Type 2 Diabetes: A meta-analysis of randomized controlled trials

Dario Giugliano (1) , Maria Ida Maiorino (1) , Giuseppe Bellastella (1) , Paolo Chiodini (1) , Katherine Esposito (1)

1 University of Naples Federico II = Università degli studi di Napoli Federico II

Aims We performed a meta-analysis of randomized controlled trials with insulin analogues in type 2 diabetes utilizing a least-squared regression model in order to assess the relationship between baseline HbA1c, the magnitude of HbA1c decrease, and attainment of HbA1c target of <7%. Methods RCTs involving insulin regimens (basal, prandial, biphasic, and basal-bolus) were identified through electronic searches (MEDLINE, EMBASE, CINAHL, and The Cochrane Library) through September 2010. We included any study arm of RCTs if they were at least 12 weeks in duration, the number of patients in any arm was more than 30, and reported the baseline HbA1c and change from baseline HbA1c . Results We found 87 studies, with a total of 135 arms, and 38803 patients. The weighted R2 values for the overall analysis assessing the association between baseline HbA1c and absolute change in HbA1c or the proportion of patients at target were 0.485 (P < 0.001) and 0.146 (P < 0.001), respectively. Subanalyses of insulin regimens for the association between basal HbA1c and absolute decrease of HbA1c produced weighted R2 which were significant for all insulin regimens, with the highest association for basal-bolus (R2 =0.719, P <0.001). Discussion The strong positive relationship between baseline HbA1c and the magnitude of HbA1c change we found in RCTs using insulin analogues in type 2 diabetes should be considered when assessing the clinical efficacy of insulin therapies.

Mots clés: Medicine

Dario Giugliano, Maria Ida Maiorino, Giuseppe Bellastella, Paolo Chiodini, Katherine Esposito. Relationship of baseline HbA1c, HbA1c change, and HbA1c target of <7% with Insulin Analogues in Type 2 Diabetes: A meta-analysis of randomized controlled trials. International Journal of Clinical Practice, 2011, 65 (5), pp.602. ⟨10.1111/j.1742-1241.2010.02619.x⟩. ⟨hal-00631703⟩