medwireNews: Older type 2 diabetes patients receiving basal insulin treatment who switch to glargine 300 units/mL (Gla-300) experience greater or similar improvements in glycemic control compared with those switching to a first-generation basal insulin, with lower hypoglycemia risk, researchers report.
The DELIVER 3 study authors used electronic medical records to compare glycemic outcomes in 2352 people aged 65 years or older with type 2 diabetes who switched their basal insulin treatment to either the second-generation agent Gla-300 or a first-generation basal insulin (insulin detemir [IDet] or insulin glargine 100 units/mL [Gla-100]).
As reported in Diabetes, Obesity and Metabolism, individuals in both the Gla-300 and IDet/Gla-100 groups experienced a significant reduction in average glycated hemoglobin (HbA1c) levels from baseline to the 3–6-month follow-up, when both variable (earliest time of treatment discontinuation or 6 months) and fixed (3–6 months) durations of follow-up were used.
Jasmanda Wu (Sanofi, Bridgewater, New Jersey, USA) and co-researchers found that the 1176 patients who switched to Gla-300 experienced significantly greater average HbA1c reductions than the 1176 propensity score-matched patients who switched to IDet/Gla-100 in the variable follow-up analysis (0.45 vs 0.29%), but not in the fixed follow-up analysis (0.48 vs 0.38%). Baseline HbA1c values in the Gla-300 and IDet/Gla-100 groups were 8.60% and 8.56%, respectively.
A comparable proportion of patients switching to Gla-300 and IDet/Gla-100 achieved target HbA1c levels below 7% (18.5 vs 19.7%) and below 8% (49.1% in both groups). Although the researchers stress that “[g]lycaemic goals for older adults should be individualized, ranging from <7.5% for otherwise healthy individuals and from <8.5% for those with complex/poor health,” they note that these two frequently recommended targets were used because “it was not possible to set individual targets for different patients” in the DELIVER 3 study.
Wu and colleagues report significantly lower rates of hypoglycemia among patients who switched to Gla-300 versus IDet/Gla-100 in the variable follow-up analysis, at 10.9% versus 14.5% over 6 months (adjusted hazard ratio [HR]=0.72), as well as rates of inpatient or emergency department-associated hypoglycemia, at 2.6% versus 4.7% over 6 months (adjusted HR=0.58).
In the fixed follow-up analysis, people in the Gla-300 group experienced a significant reduction in hypoglycemia incidence from baseline to month 3, but those in the IDet/Gla-100 did not.
“The lower risk of hypoglycaemia with Gla-300, likely due to its more evenly distributed and stable pharmacokinetic exposure and pharmacodynamic profile, is particularly important for older adults with [type 2 diabetes], who are at an increased risk of hypoglycaemia and its associated adverse events,” conclude Wu and team.
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Diabetes Obes Metab 2019; doi:10.1111/dom.13818
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