Long acting insulin analogue tied to low risk of sudden fall of blood sugar: JAMA

USA: The use of long-acting insulin analogs versus NPH insulin lowers the risk of severe hypoglycemia in older patients with type 2 diabetes (T2D), finds a recent study in the journal JAMA Internal Medicine.

Previous studies found no difference in the risk of severe hypoglycemia or sudden fall of blood sugar between the use of long-acting insulin analogs and neutral protamine Hagedorn (NPH) insulin in T2D patients. However, these studies were not focused on patients 65 years or older who are at increased hypoglycemia risk, or did not included patients with concomitant prandial insulin use.

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. 

"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