AHRQ's comparative effectiveness research on premixed insulin analogues for adults with type 2 diabetes: understanding and applying the systematic review findings.

BACKGROUND: Among people with type 2 diabetes who have severe pancreatic Beta-cell dysfunction, exogenous insulin treatment is essential for controlling glycemia and reducing risks of disease-related complications and mortality. Conventional human insulin preparations are limited by their slow absorption and inability to adequately match the complex basal-bolus pattern of physiologic insulin activity. The development of insulin analogues, including premixed formulations that are designed to mimic physiologic insulin activity, has advanced diabetes management and afforded patients more convenient treatment options. Until recently, however, the benefits and harms of premixed insulin analogues had not been compared with outcomes of other insulin therapies and noninsulin oral antidiabetic agents. In 2008, under the auspices of the Agency for Healthcare Research and Quality (AHRQ), a systematic comparative effectiveness review on this topic was published.

OBJECTIVE: To familiarize health care professionals with the AHRQ comparative effectiveness report on premixed insulin analogues, and to offer and encourage reflections on practical applications of the systematic review findings.

SUMMARY: The comparative effectiveness and safety of premixed insulin analogues vary by comparator therapies and outcomes of interest. The AHRQ systematic review indicated that premixed insulin analogues are more effective than long-acting insulin analogues in lowering postprandial glucose and hemoglobin A1c; however, in this comparison the premixed analogues were associated with higher rates of hypoglycemia and more weight gain. Similar effectiveness and safety findings were obtained through the comparison of premixed insulin analogues and noninsulin antidiabetic drugs. Many comparisons did not yield firm conclusions due to a lack of studies or weak evidence.