Severe Hypoglycemia Risk With Long-Acting Insulin Analogs vs Neutral Protamine Hagedorn Insulin
Cohort study (n=575,008) found long-acting insulin analogues linked to lower risk of emergency department visits or hospitalizations for hypoglycaemia vs. NPH insulin (HR for glargine vs NPH 0.71; 95% CI, 0.63-0.80; HR, detemir vs NPH, 0.72; 95% CI, 0.63-0.82) in older patients.
Source:
JAMA Internal Medicine
SPS commentary:
A commentary notes that meta-analyses of RCTs have found no significant difference in severe hypoglycaemia rates among patients with type 2 diabetes randomized to long-acting basal insulin analogues compared with insulin isophane suspension. It discusses possible reasons for these differing findings. It notes that the basal insulin treatment choice should be viewed as one tool among many in the broader clinical and public health effort to reduce hypoglycaemia among older adults. It adds that it is critical to step back from the decision to initiate insulin use and ask whether this will improve patient-centered goals of care, as for many older patients, insufficient effort is devoted to discussing these goals and setting individualized glycaemic targets. Furthermore, less intensive glycaemic targets may reduce the need to initiate insulin use, and it suggests in terms of alternative therapeutics, some patients in this study may now be candidates for sodium glucose cotransporter 2 inhibitors or glucagon-like peptide 1 agonists, drugs with low associated rates of hypoglycaemia.