Problem Is the problem a priority?
Judgment	Research evidence	Additional considerations
Yes	Hypoglycemia has a major impact on quality of life of insulin-treated patients32, and it represents a major obstacle for attaining desired glycemic goals Available data suggest that different long-acting insulin formulations are associated with different risk of hypoglycemia in type 2 diabetes33, 34
Desirable Effects How substantial are the desirable anticipated effects?
Judgment	Research evidence	Additional considerations
Large	Effects of long-acting basal insulin analogues with longer vs shorter duration Total hypoglycemia: -32% Nocturnal hypoglycemia: -31% No significant effect on severe hypoglycemia
Undesirable Effects How substantial are the undesirable anticipated effects?
Judgment	Research evidence	Additional considerations
Trivial	No relevant increase of any adverse event reported in clinical trials for the intervention vs comparator
Certainty of evidence What is the overall certainty of the evidence of effects?
Judgment	Research evidence	Additional considerations
Low	Low for total hypoglycemia; moderate for the other critical outcomes
Values Is there important uncertainty about or variability in how much people value the main outcomes?
Judgment	Research evidence	Additional considerations
No important uncertainty or variability	No expected uncertainty or variability
Balance of effects Does the balance between desirable and undesirable effects favor the intervention or the comparison?
Judgment	Research evidence	Additional considerations
Favors the intervention	The balance of effects of using the intervention instead of comparison is favorable for the reduction of total and nocturnal hypoglycemia
Resources required How large are the resource requirements (costs)?
Judgment	Research evidence	Additional considerations
Varies	Relevant direct costs35	The introduction of biosimilars reduced the average cost of out-of-patent long-acting insulin analogues
Certainty of evidence of required resources What is the certainty of the evidence of resource requirements (costs)?
Judgment	Research evidence	Additional considerations
High	Several good-quality studies explored this issue
Cost-effectiveness Does the cost-effectiveness of the intervention favor the intervention or the comparison?
Judgment	Research evidence	Additional considerations
Probably favors the intervention	Pharmaeconomic studies showed that direct costs of drugs is generally increased with newer formulations although the cost-effectiveness ratio generally suggests good value for money because of the implication in terms of both QALY and the effects on the risk of events, weight gain etc.; the availability of biosimilars contains the cost of out-of-patent insulin analogues	The introduction of biosimilars reduced the average cost of out-of-patent long-acting insulin analogues, thus modifying the evaluation on cost-effectiveness ratio
Equity What would be the impact on health equity?
Judgment	Research evidence	Additional considerations
Probably no impact	No impact expected (long-acting analogues with longer duration are already the standard of care)
Acceptability Is the intervention acceptable to key stakeholders?
Judgment	Research evidence	Additional considerations
Probably yes	Long-acting analogues with longer duration are already the standard of care
Feasibility Is the intervention feasible to implement?
Judgment	Research evidence	Additional considerations
Yes	Long-acting analogues with longer duration are already the standard of care