Premixed insulin lispro versus insulin glargine in type 2 diabetes: A meta-analysis

Objectives: To systematically review the effectiveness and safety of premixed insulin lispro and insulin glargine in type 2 diabetes. Methods: Such databases as PubMed, EMBASE, The Cochrane Library, ClinicalTrials.gov, CBM, CNKI and WanFang were searched for relevant studies from inception to October, 2013. Two reviewers independently screened studies according to exclusion and inclusion criteria, extracted data and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.2 software. Results: 13 RCTs involving 4267 patients were included. The results of meta-analysis showed that, compared to insulin glargine, premixed insulin lispro effectively improved HbA1c levels [WMD= -0.18, 95%CI (-0.33, -0.02), P= 0.03(parallel trials), WMD= -0.38,95%CI(-0.52,-0.24), P< 0.00001 (cross-over trials)]. However, insulin glargine effectively improved FPG levels [WMD= 0.82,95%CI(0.65, 0.99), P< 0.00001 (parallel trials)]; WMD= 0.64,95%CI(0.26, 1.02), P= 0.0009 (cross-over trials)], weight gain[WMD= 0.93, 95%CI(0.31,1.56), P= 0.003 (parallel trials); WMD= 0.74, 95%CI(0.19,1.29), P= 0.009(cross-over trials)] and decrease hypoglycemia incidence[OR= 1.26, 95%CI(1.10, 1.45), P= 0,0007(parallel trials), OR= 2.24, 95%CI(1.45, 3.46), P= 0.0003(cross-over trials)]. Conclusions: : Premixed insulin lispro and insulin glargine have different advantages in clinical efficacy. Doctors should select the appropriate insulin treatment according to the patient's health condition and efficacy target.