DSEN Abstract
How does real world use of insulin glargine compare to NPH insulin in terms of effectiveness and safety for the management of type 1 diabetes mellitus (T1DM)?

*This research was funded by the Drug Safety and Effectiveness Network (DSEN) and conducted by the following investigators: Cristiano Moura, Sasha Bernatsky, Michal Abrahamowicz, Louise Pilote and the CAN-AIM Team. The statements made herein are those of the stated authors, who are independent researchers.

What is the issue?

  • Despite some evidence suggesting that the newer long acting insulin analogues such as glargine might produce a better profile of basal insulin than neutral protamine Hagedorn (NPH) insulin in type 1 DM, a strong clinical benefit for this newer agent is not clear.

Implications and Key Messages

  •  Our analyses did not confirm any clinical outcome differences between NPH and glargine in terms of hypoglycemia, KDA, and microvascular complications. The higher rate of switches in NPH initiators could have been due to patient and physician choice rather than to adverse effects. Given the paucity of real-world comparisons of insulin therapy on T1DM population to date, our study is useful. However, future evaluations should try to elucidate causes for discontinuation and switching and the impact of these events on later clinical outcomes.
  •  Type 1 diabetes mellitus patients initiating NPH insulin are more likely to switch to another insulin therapy during their treatment. Our results did not clearly indicate that NPH initiators who persist on their therapy have any different risks of hypoglycemia, KDA, and microvascular complications when compared to glargine initiators.

For more information, please contact Louise Pilote: louise.pilote@mcgill.ca.

What was the aim of the study?

  • To compare insulin glargine with NPH insulin in terms of effectiveness and safety for the management of patients with type 1 diabetes mellitus (T1DM).

How was the study conducted?

  • CAN-AIM conducted a longitudinal analysis from an international database to compare therapy persistence, measured as discontinuation and switching, hypoglycaemia, diabetes ketoacidosis (DKA), and microvascular complications (nephropathy, retinopathy, and neuropathy) among insulin glargine and NPH insulin initiators.

What did the study find?

  • Initiators of NPH were more likely to switch to another insulin therapy than initiators of glargine.
  • We were unable to establish that the risk of hypoglycemia, DKA, and microvascular complications was different in initiators of NPH versus glargine.
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