medwireNews: Older individuals with type 2 diabetes and low glycated hemoglobin (HbA1c) receiving treatment with a sulfonylurea or insulin have an increased risk for severe hypoglycemia, but there is no clear indication of an increased mortality risk, suggest UK study results.
The analysis included data from 22,857 individuals at least 70 years of age with type 2 diabetes, obtained from a UK primary care database, who comprised two groups. The exposed group was formed by 6288 individuals who had three consecutive HbA1c measurements below 7% (53 mmol/mol) while on insulin (9.2%) and/or a sulfonylurea (90.0%) within 60 days prior to the third HbA1c measurement date, and these people were matched with 16,569 non-exposed individuals.
During a median follow up of 4.9 years, 6.1% of individuals were hospitalized for severe hypoglycemia, with rates of 17.5 and 9.2 per 1000 person–years in the exposed and non-exposed groups, respectively.
Suping Ling (University Hospital Leicester, UK) and co-authors report that when adjusting for a range of factors including age, sex, ethnicity, and BMI, exposed individuals were significantly more likely to be hospitalized for a hypoglycemia event than non-exposed individuals; at a hazard ratio of 2.52.
“Regardless of age, the risk of severe hypoglycemia was always higher in the exposed than in the non-exposed subjects,” the investigators say. The 10-year absolute risk differences between exposed and non-exposed individuals were 7.7%, 8.1%, 8.6%, and 8.4% in individuals aged 70, 75, 80, and 85 years, respectively.
On the other hand, Ling et al found no significant associations between drug exposure and mortality risk. Rates of cardiovascular disease (CVD)-related and non-CVD-related mortality estimates per 1000 person–years were 29.7 versus 29.1 and 59.6 versus 56.7 in the exposed and non-exposed groups, respectively. They say that there were “marginal absolute risk differences across ages and over time” for exposed versus non-exposed individuals.
The team notes that “extensive supplemental analyses” demonstrated that “treatment with insulin or a sulfonylurea, rather than the low HbA1c levels alone, is the key prognostic factor” for adverse outcomes. They explain that in exposed subjects on insulin and/or a sulfonylurea, risk for severe hypoglycemia and mortality was higher than among those on any other glucose-lowering medications.
Writing in Diabetes Care, the authors conclude: “In view of the increasing prevalence of multimorbid, older patients with type 2 diabetes, and the prognostic role of insulin and sulfonylureas, further research is warranted to explore the net clinical beneﬁt of deintensiﬁcation by replacement of these treatments with other glucose-lowering medications in these patients.”
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