Efficacy and Safety of Insulin Glargine Compared to Other Interventions in Younger and Older Adults: A Pooled Analysis of Nine Open-Label, Randomized Controlled Trials in Patients with Type 2 Diabetes
- First Online:
- 378 Downloads
Elderly patients with type 2 diabetes mellitus (T2DM) present therapeutic challenges related to co-morbidities, treatment adherence, and safety. This study examines the efficacy and safety of insulin glargine compared to other glucose-lowering interventions in younger and older adults.
In this pooled analysis of 24-week data from nine prospective open-label, multicenter, phase 3/4, two-arm, parallel-group, randomized controlled trials, patients with T2DM aged 18–80 years received insulin glargine (used as a basal insulin regimen) or comparators (including rosiglitazone, pioglitazone, insulin lispro, insulin lispro 75/25, NPH insulin, NPH insulin 30/70, and lifestyle/dietary measures). Endpoints included change from baseline to week 24 in: glycated hemoglobin; fasting plasma glucose; body weight; body mass index; insulin dose; incidence of nocturnal, daytime, or any hypoglycemia. Results were stratified by age (<65, ≥65, 65–74, and ≥75 years) and treatment (insulin glargine or comparator).
A total of 2,938 patients were included (2,263 aged <65 years, 675 aged ≥65 years). Similar levels of glycemic control were achieved in both younger (<65 years) and older (≥65 years) patients with T2DM. Insulin glargine was associated with better glycemic control and a reduced incidence of daytime and any hypoglycemia versus comparator interventions in both younger and older T2DM patients.
This analysis suggests that insulin glargine may represent a safe option to improve glycemic control in older patients with T2DM.
- 1.American Diabetes Association. Standards of medical care in diabetes—2012. Diabetes Care. 2012;35(Suppl 1):S11–63.Google Scholar
- 13.Pandya N, DiGenio A, Patel M. Insulin glargine vs comparators in adults <65 vs ≥65 years of age. Diabetes. 2011;60(Suppl. 1):A610.Google Scholar
- 14.Patel M, DiGenio A, Pandya N. Pooled analysis reveals greater glycemic control with insulin glargine vs comparators in adults aged 65–74 and ≥75 years. Diabetes 2011;60(Suppl. 1):A617.Google Scholar
- 16.Gerstein HC, Yale JF, Harris SB, et al. A randomized trial of adding insulin glargine vs. avoidance of insulin in people with type 2 diabetes on either no oral glucose-lowering agents or submaximal doses of metformin and/or sulphonylureas. The Canadian INSIGHT (Implementing New Strategies with Insulin Glargine for Hyperglycaemia Treatment) Study. Diabet Med. 2006;23:736–42.PubMedCrossRefGoogle Scholar
- 23.California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes. Guidelines for improving the care of the older person with diabetes mellitus. J Am Geriatr Soc. 2003;51(5 Suppl Guidelines):S265–80.Google Scholar
- 26.ADVANCE Collaborative Group, Patel A, MacMahon S, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560–72.Google Scholar
- 27.Ray KK, Seshasai SR, Wijesuriya S, et al. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials. Lancet. 2009;373:1765–72.Google Scholar
- 29.Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2012;55:1577–96.Google Scholar
- 30.Davis KL, Wei W, Meyers J, et al. A retrospective study of basal insulin analogs in elderly nursing home residents with type-2 diabetes. J Am Geriatr Soc. 2012;60 (Suppl S4):S51.Google Scholar
- 33.Miller ME, Bonds DE, Gerstein HC, et al. The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: post hoc epidemiological analysis of the ACCORD study. BMJ. 2010;340:b5444.Google Scholar
- 34.Schultes B, Baron M, Bremer JP, et al. Reduced awareness of hypoglycaemia in elderly patients with type 2 diabetes. Diabetes. 2005;54(Suppl 1):Abstract 2222-PO.Google Scholar