medwireNews: Elderly people with type 2 diabetes who start treatment with long-acting insulin analogues have a lower risk of severe hypoglycemia than people who use protamine hawthorn insulin (NPH).
Marie Bradley of the US FDA in Silver Spring, Maryland, and colleagues evaluated Medicare data from 575,008 people aged 65 and over (mean 75 years) with type 2 diabetes who took insulin glargine (n = 407,018) and insulin detemir ( n =) initiated 141,588) or NPH insulin (n = 26,402) between 2007 and 2019.
During a median follow-up of 0.37 years, there were 5194 cases of severe hypoglycemia requiring an emergency room visit or hospitalization in the glargine group, 1693 in the detemir group and 460 in the NPH group.
In an analysis weighted with the propensity score, people in the glargine group had a significantly 29% lower risk of severe hypoglycemia than people in the NPH group, with weighted incidence rates of 17.37 and 26.64 per 1000 person-years, respectively. Similarly, those who took Detemir had a significantly 28% reduced risk compared to those who took NPH, with weighted incidence rates of 16.69 and 25.04 per 1000 person-years, respectively.
“In terms of the number of patients required for harm, one would have to treat 154 patients with glargine or 167 with detemir instead of NPH insulin for a year to prevent an excessive case of severe hypoglycemia,” explain the researchers at JAMA Internal Medicine.
They say their results are in contrast to previous study results showing similar rates of severe hypoglycemia in people with type 2 diabetes taking long-acting insulin analogues compared to NPH insulin, and suggest that “age may increase has contributed to different study results “. In fact, the previous study included younger patients (mean age 60 years), and Bradley and his team said there was a “potential change in effect by age” in the current study, with the strongest protective association in people aged 69 and over was observed up to 87 years.
The authors of the study also found that prandial insulin significantly changed the protective association between long-term insulin consumption and severe risk of hypoglycaemia, although no significant associations were found during periods of prandial insulin use.
“This is an important finding and suggests that the benefits of long-acting analogs in hypoglycemia seen in the main analysis, at least in certain age groups, may not be apparent when the patient is on prandial insulin at the same time,” they write.
Bradley and his team posit that “[t]The inclusion of prandial insulin in treatment regimens for type 2 diabetes can add complexity, especially in older users, increasing the possibility of using too much insulin, which can increase the likelihood of hypoglycemia to such an extent that the benefits When compared with long-acting analogs, NPH insulin is lost. “
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JAMA Intern Med 2021; doi: 10.1001 / jamainternmed.2020.9176
