Hypoglycaemia: insulin glargine led to fewer hypoglycaemic episodes than standard insulin in patients with type 1 diabetes on intensive regimens

Clinical bottom line (level 1b)

  1. Patients with type 1 diabetes on intensive insulin therapy who took insulin glargine compared with standard insulin were less likely to have hypoglycaemic episodes (NN T = 11 at 28 weeks) , including severe ones (NN T = 27 at 28 weeks) .
Ratner et al: Diabetes Care 2000; 23 : 639-643
Expires October 2003

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: 5 diabetes clinic, university hospitals, USA

534 patients (aged aged 18 to 80; mean 39, 51% male) with type 1 diabetes

Excluded if

Control Group: (n = 270, 270 analysed): human NPH insulin
Experimental Group: (n = 264, 264 analysed): insulin glargine

0% followed for 28 weeks
Outcome notes:
  • hypoglycaemia : blood glcuose < 2.0 mmol/l
  • serious hypoglycaemia : death, life-threatening event, hospitalization, or medical intervention to prevent permanent impairment

The evidence

Outcome Time to outcome CER EER RRR
(95% CI)		 ARR
(95% CI)		 NN T
(95% CI)
hypoglycaemia 28 weeks 133
(49.3%)		 105
(39.8%)		 19%
(2% to 33%)		 9.49%
(1.09% to 17.9%)		 11
(6 to 91)
serious hypoglycaemia 28 weeks 15
(5.56%)		 5
(1.89%)		 66%
(8% to 87%)		 3.66%
(0.47% to 6.85%)		 27
(15 to 210)

Citation

  1. Ratner RE, Hirsch IB, Neifing JL, et al: less hypoglycaemia with insulin glargine in intensive insulin therapy for type 1 diabetes. Diabetes Care 2000; 23 : 639-643
Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, October 2001
Reviewer:

Clinical Question.
Patient type 1 diabetes mellitus
Intervention or Exposure insulin glargine
Outcome hypoglycaemia, glycaemic control