Degludec benefits consistent in elderly patients
medwireNews: Degludec delivers the same magnitude of protection against hypoglycemia relative to glargine across patient age groups, shows analysis of the SWITCH 2 and DEVOTE trials.
And the DEVOTE analysis also shows that the cardiovascular safety of the long-acting insulin is similar in older and younger patients, the researchers reported at the ADA’s 78th Scientific Sessions in Orlando, Florida, USA.
SWITCH 2 was a randomized crossover trial, involving 720 patients with type 2 diabetes, whose primary finding was a 30% reduced risk for severe hypoglycemia among patients taking degludec versus glargine. This post hoc analysis, presented by Simon Heller (University of Sheffield, UK), showed that the 270 patients who were older than 65 years tended to have more severe hypoglycemia than the 450 younger patients, although there was no difference for symptomatic or nocturnal hypoglycemia.
Despite this, risk for symptomatic hypoglycemia was reduced to a similar degree by degludec versus glargine in both the older and younger age groups, by 30% and 31%, respectively, and the same was true for nocturnal hypoglycemia and severe hypoglycemia, although the latter reductions were nonsignificant because of the small number of events.
However, in response to a comment from the audience, Heller agreed that it might be more appropriate to stratify patients based on frailty rather than age when looking for differences in treatment response.
Following on from Heller, Richard Pratley (Florida Hospital Diabetes Institute, Orlando, USA) presented age-specific results for the 7637 patients with type 2 diabetes in the degludec cardiovascular outcomes study, DEVOTE.
For this analysis, patients were divided into three age groups: 50–64 years (n=3682); 65–74 years (n=3136); and 75 years or older (n=819). Medication use was similar across age groups. Patients in the oldest age group had a significantly higher risk for severe hypoglycemia than younger patients, and also for major adverse cardiovascular events (MACE) and mortality.
But in line with SWITCH 2, the 40% reduction in severe hypoglycemia reported for degludec versus glargine in the DEVOTE primary analysis was observed across the three age groups, albeit nonsignificant in the oldest group because of the small number of patients and events.
And there was also no interaction between age and treatment for the outcomes of MACE and mortality, so the neutral effect of degludec in the overall population was observed across all three age categories.
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