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07-11-2019 | Insulin glargine | News

Support for Gla-300 use in older people with type 2 diabetes


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.

By Claire Barnard

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Diabetes Obes Metab 2019; doi:10.1111/dom.13818

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