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A review of the NG17 recommendations for the use of basal insulin in type 1 diabetes

Steve Bain Orcid Logo, M. Feher, M. Fisher, N. Hex Orcid Logo, K. C. S. Lee, J. Mahon, D. Russell‐Jones, H. Schou, E. G. Wilmot Orcid Logo, M. Baxter

Diabetic Medicine, Volume: 37, Issue: 2, Pages: 219 - 228

Swansea University Author: Steve Bain Orcid Logo

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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...

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Published in: Diabetic Medicine
ISSN: 0742-3071 1464-5491
Published: Wiley 2020
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URI: https://cronfa.swan.ac.uk/Record/cronfa52764
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spelling 2022-12-02T19:27:54.1377548 v2 52764 2019-11-18 A review of the NG17 recommendations for the use of basal insulin in type 1 diabetes 5399f4c6e6a70f3608a084ddb938511a 0000-0001-8519-4964 Steve Bain Steve Bain true false 2019-11-18 MEDS 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. Journal Article Diabetic Medicine 37 2 219 228 Wiley 0742-3071 1464-5491 1 2 2020 2020-02-01 10.1111/dme.14180 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Sanofi 2022-12-02T19:27:54.1377548 2019-11-18T09:48:31.4664748 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Steve Bain 0000-0001-8519-4964 1 M. Feher 2 M. Fisher 3 N. Hex 0000-0002-6181-9429 4 K. C. S. Lee 5 J. Mahon 6 D. Russell‐Jones 7 H. Schou 8 E. G. Wilmot 0000-0002-8698-6207 9 M. Baxter 10 52764__25995__f467eae65258415595be57e3e2fd5865.pdf 52764.pdf 2022-12-02T19:26:44.5097975 Output 385883 application/pdf Version of Record true Copyright 2019 The Authors. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License true eng http://creativecommons.org/licenses/by-nc-nd/4.0/
title A review of the NG17 recommendations for the use of basal insulin in type 1 diabetes
spellingShingle A review of the NG17 recommendations for the use of basal insulin in type 1 diabetes
Steve Bain
title_short A review of the NG17 recommendations for the use of basal insulin in type 1 diabetes
title_full A review of the NG17 recommendations for the use of basal insulin in type 1 diabetes
title_fullStr A review of the NG17 recommendations for the use of basal insulin in type 1 diabetes
title_full_unstemmed A review of the NG17 recommendations for the use of basal insulin in type 1 diabetes
title_sort A review of the NG17 recommendations for the use of basal insulin in type 1 diabetes
author_id_str_mv 5399f4c6e6a70f3608a084ddb938511a
author_id_fullname_str_mv 5399f4c6e6a70f3608a084ddb938511a_***_Steve Bain
author Steve Bain
author2 Steve Bain
M. Feher
M. Fisher
N. Hex
K. C. S. Lee
J. Mahon
D. Russell‐Jones
H. Schou
E. G. Wilmot
M. Baxter
format Journal article
container_title Diabetic Medicine
container_volume 37
container_issue 2
container_start_page 219
publishDate 2020
institution Swansea University
issn 0742-3071
1464-5491
doi_str_mv 10.1111/dme.14180
publisher Wiley
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description 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.
published_date 2020-02-01T02:05:08Z
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