Marie C. Bradley, S Food and Drug Administration, Silver Spring, Maryland, and colleagues aimed to examine the risk of emergency department (ED) visits or hospitalizations for hypoglycemia among older community-residing patients with type 2 diabetes who initiated long-acting insulin or NPH insulin in real-world settings.
For the purpose, the researchers performed a retrospective, new-user cohort study and assessed Medicare beneficiaries 65 years or older who initiated insulin glargine (n = 407 018), insulin detemir (n = 141 588), or NPH insulin (n = 26 402) from January 1, 2007, to July 31, 2019.
The primary outcome was time to first ED visit or hospitalization for hypoglycemia, defined using a modified validated algorithm.
Key findings of the study include:
- The study included 7347 ED visits or hospitalizations for hypoglycemia (5194 for glargine, 1693 for detemir, and 460 for NPH insulin, with a median follow-up across the 3 cohorts of 0.37 years (interquartile range, 0.20-0.76 years).
- Initiation of glargine and detemir use was associated with a reduced risk of hypoglycemia compared with NPH insulin use (HR for glargine vs NPH insulin, 0.71; HR, detemir vs NPH insulin, 0.72).
- The HRs were similar for the recurrent event analysis.
- The protective association of long-acting insulin analogs varied by age and was not seen with concomitant prandial insulin use.
"In this cohort study, initiation of long-acting analogs was associated with a lower risk of ED visits or hospitalizations for hypoglycemia compared with NPH insulin in older patients with type 2 diabetes in Medicare. However, this association was not seen with concomitant prandial insulin use," wrote the authors.
"Put another way, the findings suggest a need for caution for the use of insulin isophane suspension among Medicare beneficiaries, particularly those who may be at greatest risk for hypoglycemia," they write.
"For the individual older patient, the decision to initiate insulin use has to be made with an open discussion of the risks and benefits, taking into account the overall goals of care, the capacity of the patient to perform the treatment plan safely, and practical considerations, such as out-of-pocket costs and type of delivery (pen vs vial)," Dr. Elbert Huang with University of Chicago, Illinois, and Dr. Kasia Lipska with Yale University, New Haven, Connecticut.
The study titled, "Severe Hypoglycemia Risk With Long-Acting Insulin Analogs vs Neutral Protamine Hagedorn Insulin," is published in the journal JAMA Internal Medicine.
DOI: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2777049
Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.
NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.