BACKGROUND AND PURPOSE:

• Bradley et al. (JAMA Intern Med., 2021) compared hypoglycemia risk between long-acting insulin vs NPH insulin among older individuals with type 2 diabetes

METHODS:

• Retrospective, new-user cohort study
• Participants
  • Medicare beneficiaries ≥65 years
  • Initiated long-acting insulin or NPH insulin
• Exposures
  • Insulin glargine
  • Insulin detemir
  • NPH insulin
• Study design
  • Propensity score hazards regression was used to estimate hazard ratio (HR) and 95% CIs
  • The risk of recurring hypoglycemia events was estimated
  • Post hoc analyses were conducted to assess contribution of age
• Primary outcome
  • Time to first ED visit or hospitalization for hypoglycemia

RESULTS:

• 575,008 patients initiating use of insulin
  • Mean age 74.9 years | 53% female
  • Glargine: 407,018 patients | Detemir: 141,588 | NPH insulin: 26,402
  • Median follow-up across the 3 cohorts was 0.37 (IQR 0.20 to 0.76) years
  • The majority of patients were also using oral diabetic medications
• ED visits or hospitalizations for hypoglycemia | Overall: 7347 events
  • Glargine: 5194 events
  • Detemir: 1693 events
  • NPH insulin: 460 events
• Initiation of glargine and detemir use was associated with a reduced risk of hypoglycemia compared with NPH insulin
  • Glargine vs NPH insulin: HR 0.71 (95% CI, 0.63 to 0.80)
  • Detemir vs NPH insulin: HR 0.72 (95% CI, 0.63 to 0.82)
• The protective association of long-acting insulin analogs varied by age and was not seen with concomitant prandial insulin use

CONCLUSION:

• In type 2 diabetes patients 65 years or older in Medicare, initiation of long-acting analogs was associated with a lower risk of ED visits or hospitalizations for hypoglycemia vs NPH insulin
• This association was not seen with concomitant prandial insulin use
• The authors state

The inclusion of prandial insulin in type 2 diabetes treatment regimens may increase complexity, especially for older users, thereby increasing the possibility of using too much insulin, which might increase the likelihood of hypoglycemia to such an extent that the benefits from long-acting analogs compared with NPH insulin are lost 

Learn More – Primary Sources:

Severe Hypoglycemia Risk With Long-Acting Insulin Analogs vs Neutral Protamine Hagedorn Insulin

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RCT Results: Once-Weekly Insulin Injection for Type 2 Diabetes

Can Lifestyle Interventions with Trained Lay Volunteers Reduce Risk of Developing Type 2 Diabetes?