ORIGINAL฀ARTICLE฀ Long‑acting฀insulin฀analogue฀detemir฀compared฀with฀NPH฀insulin... 237 IntroductIon Current strategies for the treat‑ ment of type 1 diabetes with insulin involve the use of basal‑bolus therapy to maintain near normoglycemia in order to prevent long‑term complications. 1,2 Te replacement of endogenous basal insulin is difcult to achieve with current‑ ly available human insulin preparations such as intermediate‑acting Neutral Protamine Hagedorn (NPH) insulin. Tis insulin formulation is associ‑ ated with a high day‑to‑day variation in insulin absorption of 20%–30% and a changing insulin concentration before each administration due to inadequate resuspension. 3 Furthermore, pro‑ nounced insulin peaks 5–7 hours after injection increase the risk of nocturnal hypoglycemia and the peak duration is too short to maintain glyce‑ mic control throughout the night. 4 Tese pharma‑ cokinetic properties of NPH insulin may result in an increased risk of nocturnal hypoglycemic epi‑ sodes and hyperglycemic escape before breakfast. orIGInAL ArtIcLE Long‑acting insulin analogue detemir compared with NPH insulin in type 1 diabetes A systematic review and meta‑analysis Agnieszka Szypowska 1 , Dominik Golicki 2 , Lidia Groele 1 , Ewa Pańkowska 3 1 Department of Paediatrics, Medical University of Warsaw, Warszawa, Poland 2 Department of Pharmacoeconomics, Medical University of Warsaw, Warszawa, Poland 3 Institute of Mother and Child, Warszawa, Poland Correspondence to: Agnieszka Szypowska, MD, PhD, Klinika Pediatrii, Samodzielny Publiczny Dziecięcy Szpital Kliniczny, ul. Działdowska 1, 01-184 Warszawa, Poland, phone/fax: +48-22-452-33-09, e-mail: agnieszka.szypowska@gmail.com Received: June 1, 2011. Revision accepted: August 11, 2011. Conflict of interest: declared (see Acknowledgments). Pol Arch Med Wewn. 2011; 121 (7-8): 237-246 Copyright by Medycyna Praktyczna, Kraków 2011 AbstrAct IntroductIon Although numerous studies showed an improvement in glycemic control in type 1 diabetic patients treated with long‑acting insulin analogue detemir compared with Neutral Protamine Hagedorn (NPH) insulin, the beneficial effects of insulin detemir has not been confirmed by all investigators. objEctIvEs The aim of the study was to compare the effect of treatment with detemir insulin vs. NPH insulin on metabolic control, hypoglycemic episodes, and body weight gain in patients with type 1 diabetes by means of a systematic review and a meta‑analysis. MEthods The following electronic databases were searched up to November 2010: MEDLINE, EMBASE, and the Cochrane Library. Additional references were obtained from the reviewed articles. Only randomized controlled trials of at least 12‑week duration with basal‑bolus regimen therapies using detemir insulin vs. NPH insulin were included. rEsuLts The analysis included 10 studies involving 3825 patients with type 1 diabetes. Combined data from all trials showed a statistically significant reduction in hemoglobin A 1c (HbA 1c ) (weighted mean difference: [WMD] –0.073, 95% CI –0.135 to –0.011, P = 0.021) in the detemir group compared with the NPH group. There was also a significant reduction of fasting plasma glucose (FPG) (WMD –0.977 mmol/l, 95% CI –1.395 to –0.558, P <0.001), all‑day hypoglycemic episodes (relative risk [RR] 0.978, 95% CI 0.961–0.996), severe hypoglycemic episodes (RR 0.665, 95% CI 0.547–0.810), nocturnal hypoglycemic episodes (RR 0.877, 95% CI 0.816–0.942), as well as smaller body weight gain (WMD –0.779 kg, 95% CI –0.992 to –0.567) in patients using detemir insulin compared with those using NPH insulin. concLusIons Basal‑bolus treatment with insulin detemir, as compared with NPH insulin, provided a minor benefit in terms of the HbA 1c value and significantly reduced FPG in type 1 diabetic patients. Treatment with detemir insulin was also superior to NPH insulin in reducing the risk of all‑day, nocturnal, and severe hypoglycemic episodes, with the added benefit of reduced weight gain. KEy words basal‑bolus therapy, detemir, fasting plasma glucose, HbA 1c , NPH insulin