Switching to insulin glargine 300 IU/mL vs 100 IU/mL in older T2D patients

  • Bailey TS & al.
  • Diabetes Obes Metab
  • 2 Jul 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In older patients with type 2 diabetes (T2D), switching to insulin glargine 300 units/mL (Gla-300) was associated with greater or similar improvements in glycaemic control and less hypoglycaemia incidence, event rates and healthcare resource utilisation compared with switching to insulin glargine 100 units/mL (Gla-100 units/mL) or insulin detemirs (IDet).

Why this matters

  • Older age group is important because they account for ~40% of patients with T2D are at an increased risk of hypoglycaemia and its sequelae and are underrepresented in clinical trials.

Study design

  • DELIVER 3 study of electronic medical records included 1176 older patients (age, ≥ 65 years) with T2D who switched from basal insulin to Gla-300 and 1176 propensity score-matched patients who switched to IDet or Gla-100.
  • Main outcomes: follow-up (variable and fixed) haemoglobin A1c (HbA1c), HbA1c goal achievement (
  • Funding: Sanofi.

Key results

  • Following basal insulin switching, Gla-300 vs IDet/Gla-100 group had greater/similar reduction in HbA1c by variable (−0.45%±1.40% vs −0.29%±1.57%; P=.021) and fixed (−0.48%±1.49% vs −0.38%±1.59%; P=.114) follow-up, respectively.
  • No difference was observed in HbA1c goal achievement between Gla-300 and IDet/Gla-100 group.
  • By variable follow-up, Gla-300 vs IDet/Gla-100 group was associated with lower risk for:
    • hypoglycaemia (adjusted rate ratio [aRR], 0.63; 95% CI, 0.53-0.75; P<.001 and>
    • inpatient- (adjusted HR, 0.58; 95% CI, 0.37-0.90; P=.016) and emergency department-associated hypoglycaemia (aRR, 0.43; 95% CI, 0.31-0.60; P<.001>
  • Hypoglycaemia-related inpatient incidence (adjusted OR, 0.38; 95% CI, 0.18-0.83; P=.015) and event rates (aRR, 0.27; 95% CI, 0.12-0.58; P<.001 and inpatient days ci p were significantly lower in gla-300 vs idet group.>

Limitations

  • Retrospective design and short follow-up.
  • Risk for selection bias.

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