How Effective are Premixed Insulins?

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Systematic review: comparative effectiveness and safety of premixed insulin analogues in type 2 diabetes, by Rehan Qayyum and colleagues. Annals of Internal Medicine 149:549–559, 2008

What is the problem and what is known about it so far?

Nearly one-third of all people with type 2 diabetes use insulin, either alone or with diabetes pills. There are several different types of insulin, including products that are like the insulin produced by the human body and others, called "analogs," that have been altered to have different characteristics. Different types of insulin act for different lengths of time in the body. There are also premixed insulin products, both human and analog, that combine rapid- and longer-acting insulin in single injections. Some people with type 2 diabetes use premixed insulin, but little is known about how well premixed analogs work compared to other types of insulin and diabetes pills.

Why did researchers do this particular study?

The researchers wanted to summarize available information about how well premixed insulin analogs work compared to other treatments for type 2 diabetes.

Who was studied?

The researchers looked at 45 previous studies that included a total of 14,603 adults with type 2 diabetes.

How was the study done?

The researchers searched medical indexes for publications comparing premixed insulin analogs to other diabetes treatment regimens. They also sought unpublished information from government agencies and industry. They evaluated the studies and analyzed their combined results to learn how premixed insulin analogs compare to other diabetes treatments.

What did the researchers find?

Premixed insulin analogs and premixed human insulin provide similar blood glucose control. Premixed insulin analogs may provide better glucose control than long-acting insulin analogs or diabetes pills, but they may also be more likely to cause low blood glucose. There is not yet enough research to compare premixed insulin analogs and other regimens.

What are the limitations of the study?

This analysis included only studies that were published in English. Also, available studies provided limited and inconclusive evidence about important outcomes such as the development of diabetes complications.

What are the implications of the study?

Large, long-term studies are needed to compare premixed insulin analogs with other diabetes treatments to see whether any improvements they cause in glucose control eventually lead to improved long-term health.

FOR MORE INFORMATION

Insulin Basics

Insulin Routines

ADA Guide to Insulin and Type 2 Diabetes