• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

Do Long-Acting Insulin Analogs Reduce the Risk of Severe Hypoglycemia in Older Patients with Type 2 Diabetes?

image_pdfFavoriteLoadingFavorite

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

Now You Can Get Mobile-Friendly ObG Clinical Research Summaries with ObGFirst

ObGFirst® – Try It Free! »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

Treating Type 2 Diabetes
RCT Results: Once-Weekly Insulin Injection for Type 2 Diabetes
Can Lifestyle Interventions with Trained Lay Volunteers Reduce Risk of Developing Type 2 Diabetes?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site