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Cited by 26Diabetes Management and ResearchDiabetes Treatment and ManagementDiabetes and associated disorders

Efficacy and Safety of Rapid-Acting Insulin Analogs in Special Populations with Type 1 Diabetes or Gestational Diabetes: Systematic Review and Meta-Analysis

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Nørgaard, Kirsten, Sukumar, Nithya, Rafnsson, Snorri B., Saravanan, Ponnusamy·2018·Diabetes Therapy
DOI 10.1007/s13300-018-0411-7PMC PMC5984914
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Abstract

INTRODUCTION: To assess the efficacy and safety of three available rapid-acting insulin analogs (insulins lispro, aspart and glulisine, respectively) in pregnant women, children/adolescents and people using continuous subcutaneous insulin infusion (CSII) with type 1 diabetes. METHODS: PubMed, EMBASE and Cochrane Reviews were searched electronically, and their bibliographies examined to identify suitable studies for review and inclusion in a meta-analysis. Eligible studies were randomized controlled trials that reported data on relevant clinical outcomes. A different reviewer abstracted data for each of the three subpopulations, and one reviewer abstracted data for all three. Any differences were resolved by consensus or by consulting a fourth reviewer. RESULTS: In people on CSII, rapid-acting insulin analogs lowered postprandial plasma glucose post-breakfast to a greater extent than did regular human insulin (RHI) (mean difference: - 1.63 mmol/L [95% confidence interval - 1.71; - 1.54]), with a comparable risk of hypoglycemia and a trend for lower glycated hemoglobin. In the pediatric population, glycemic control was similar with rapid-acting insulin analogs and RHI, with no safety concerns. Meta-analysis indicated severe hypoglycemic events were comparable for rapid-acting insulin analogs versus RHI (risk difference: 0.00 [95% confidence interval - 0.01; 0.01]). In the pregnancy group, insulin lispro and insulin aspart were safe and effective for both mother and fetus, with glycemic control being at least as good as with RHI. There were no data on insulin glulisine during pregnancy. CONCLUSION: Rapid-acting insulin analogs appear generally safe and effective in these special populations; however, additional trials would be helpful. FUNDING: Novo Nordisk A/S.

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  • None of the studies showed the passage of insulin analogs across the placenta.

    “none of the studies showed the passage of insulin analogs across the placenta [108,109].”

    From Gestational Diabetes Mellitus—Recent Literature Review (2022) · cites this paper as [109]

    The Results > Pregnancy section reports maternal and cord-blood antibody levels, but does not say whether insulin analogs crossed the placenta. Searches for placental transfer and passage across the placenta found only a reference title on the subject, not a finding reported in this paper. Page numbers were not available in our copy. (LLM, conf=0.70)

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Cited by

Sorted by citations

Authors
Nørgaard, K., Sukumar, N., Rafnsson, S. B., & Saravanan, P.
Affiliations
  • Hvidovre Hospital (DK)
  • University of Warwick (GB)
  • London Metropolitan University (GB)
  • George Eliot Hospital (GB)
Corresponding author
Saravanan, Ponnusamy
ORCID
Venue
Diabetes Therapy
Publisher
Springer Science and Business Media LLC
Published
2018-04-05
Volume
9
Issue
3
Pages
891-917
ISSN
  • 1869-6953 (ISSN-L)
  • 1869-6961
DOI
10.1007/s13300-018-0411-7
PMC
PMC5984914
OpenAlex
W2795372549
Cited by
26
References
4
Citations by year
2026: 1 · 2025: 1 · 2024: 3 · 2022: 5 · 2021: 5 · 2020: 5 · 2019: 4 · 2018: 2
FWCI
0.62
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Therapy (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by-nc)
  • London Met Repository (London Metropolitan University) (acceptedVersion)
  • Warwick Research Archive Portal (University of Warwick) (acceptedVersion, cc-by-nc)
Funders
Novo Nordisk
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Keywords
rapid-acting insulin analogs, insulin lispro, insulin aspart, insulin glulisine, type 1 diabetes, gestational diabetes mellitus, insulin pump therapy, children and adolescents, pregnancy, glycemic control, hypoglycemia, HbA1c, regular insulin, postprandial blood glucose

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