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A review of the NG17 recommendations for the use of basal insulin in type 1 diabetes
,
M. Feher,
M. Fisher,
N. Hex ,
K. C. S. Lee,
J. Mahon,
D. Russell‐Jones,
H. Schou,
E. G. Wilmot ,
M. Baxter
Diabetic Medicine, Volume: 37, Issue: 2, Pages: 219 - 228
Swansea University Author:
Steve Bain
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DOI (Published version): 10.1111/dme.14180
Abstract
AimsTo revisit the data analysis used to inform National Institute of Health and Care Excellence (NICE) NG17 guidance for initiating basal insulin in adults with type 1 diabetes mellitus (diabetes).MethodsWe replicated the data, methodology and analysis used by NICE diabetes in the NG17 network meta...
| Published in: | Diabetic Medicine |
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| ISSN: | 0742-3071 1464-5491 |
| Published: |
Wiley
2020
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| Online Access: |
Check full text
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| URI: | https://cronfa.swan.ac.uk/Record/cronfa52764 |
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| Abstract: |
AimsTo revisit the data analysis used to inform National Institute of Health and Care Excellence (NICE) NG17 guidance for initiating basal insulin in adults with type 1 diabetes mellitus (diabetes).MethodsWe replicated the data, methodology and analysis used by NICE diabetes in the NG17 network meta-analysis (NMA). We expanded this data cohort to a more contemporary data set (extended 2017 NMA) and restricted the studies included to improve the robustness of the data set (restricted 2017 NMA) and in a post hoc analysis, changed the index comparator from neutral protamine Hagedorn (NPH) insulin twice daily to insulin detemir twice daily.ResultsThe absolute changes in HbA1c were similar to those reported in the NG17. However, all 95% credible intervals for change in HbA1c point estimates crossed the line of null effect, except for detemir twice daily (in the NICE and extended 2017 NMAs) and NPH four times daily. In the detemir twice-daily centred post hoc analysis, the 95% credible intervals for change in HbA1c crossed the line of null effect for all basal therapies, except NPH.ConclusionsIn NG17, comparisons of basal insulins were based solely on efficacy of glycaemic control. Many of the trials used in this analysis were treat-to-target, which minimize differences in HbA1c. In the NMAs, statistical significance was severely undermined by the wide credible intervals. Despite these limitations, point estimates of HbA1c were used to rank the insulins and formed the basis of NG17 guidance. This study queries whether such analyses should be used to make specific clinical recommendations. |
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| College: |
Faculty of Medicine, Health and Life Sciences |
| Funders: |
Sanofi |
| Issue: |
2 |
| Start Page: |
219 |
| End Page: |
228 |