Researchers looked at once-daily and twice-daily doses of both long- and intermediate-acting insulin, ranking their effectiveness, safety and cost-effectiveness.
"In patients with Type 1 diabetes, we found that long-acting insulin is superior to intermediate-acting insulin when it came to controlling blood sugar, preventing weight gain and treating severe hypoglycemia," said Dr Andrea Tricco, the lead author of the paper and a scientist in the Li Ka Shing Knowledge Institute of St Michael's Hospital.
Using data from 39 studies, Tricco and her colleagues compared two long-acting forms of insulin - glargine and detemir - against intermediate-acting forms, such as such as Neutral Protamine Hagedorn.
Intermediate-acting insulin takes between one and three hours to begin lowering blood sugar and can last up to 16 hours.
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Compared to intermediate-acting NPH, long-acting insulin significantly improved Hemoglobin A1C levels, a measure of effective blood sugar control over time.
"Those taking intermediate-acting insulin were more likely to gain weight. They gained an average of four to six pounds more than the participants who took most long-acting insulin doses," said Tricco.
Severe hypoglycemia, when someone has extremely low blood sugar, is a medical emergency where the individual is unable to treat themselves.
The researchers found that people with Type 1 diabetes were 38 per cent less likely to experience severe hypoglycemia, on average.
Tricco also looked at the cost-effectiveness between the two types of insulin.
Of the 32 studies included in the review, there were 22 analyses evaluating the economic benefits of long- and intermediate-acting insulin.
Seventy-seven per cent of those economic analyses found that long-acting insulin was more expensive but also more effective than intermediate-acting insulin. Twenty-three per cent found long-acting insulin more cost-effective.
The study was published in the journal BMJ.