medwireNews: The analysis of older participants in the BRIGHT study suggests that this subgroup may do slightly better with insulin glargine-300 than with degludec.
There were 929 people with type 2 diabetes in BRIGHT. The researchers’ pre-planned analysis of the 333 participants aged 65 and over showed similar performance of insulin glargine-300 and insulin degludec in this subgroup.
However, their post-hoc analysis of the 161 people who were 70 years or older revealed the possibility of better results in those who were randomly given Glargine-300 instead of Degludec.
In particular, the improvement in glycated hemoglobin (HbA1c) during the 24 weeks of treatment with Glargine-300 was slightly less than with Degludec in the under-1970s, by a least squares mean of 0.02%.
People aged 70 and over achieved a significantly higher reduction with Glargine-300 than with Degludec, namely by an average of 0.34% of the smallest squares.
However, there was no significant difference between treatments in the proportion of people who met their HbA1c goals in either age category.
There was no overall difference in hypoglycaemia rates during the study, although there was a slightly lower rate with Glargine-300 versus Degludec during the titration phase. This was observed for both the 65+ and 70+ subgroups and was consistent with the previously reported results across the study population.
“These results suggest that [glargine]-300 may be an effective treatment option for older people who are at higher risk of hypoglycemia and its consequences, ”write Geremia Bolli (Faculty of Medicine, University of Perugia, Italy) and co-researchers in the fields of diabetes, obesity and metabolism.
Previous results from BRIGHT indicated that people with decreased estimated glomerular filtration rate (eGFR) may have better results with Glargine-300 than with Degludec. Because the eGFR was generally lower in older participants, the researchers adjusted this factor to ensure it didn’t affect the improved HbA1c reduction with Glargine-300 in the older age group.
They report that this adjustment “slightly attenuated” the treatment difference in HbA1c reduction in people aged 70 and over, which made the heterogeneity test “nominally insignificant” at p = 0.073, but “did not change the overall conclusion”.
However, they point out the limitations of the study, including several subgroup analyzes and small numbers of participants, particularly for those aged 70 and over, and stress that “the results of these post-hoc analyzes should be interpreted appropriately”.
medwireNews is an independent medical news service from Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
Diabetes Obes Metab 2021; doi: 10.1111 / dom.14372