Glycaemic control and hypoglycaemia risk with insulin glargine 300 U/mL versus glargine 100 U/mL: A patient-level meta-analysis examining older and younger adults with type 2 diabetes

Management of hypoglycemia in older adults with type 2 diabetes

“…Like sulfonylureas, insulin is associated with a risk of hypoglycemia [14] and should be used with caution in older adults. However, newer insulin analogs, such as insulin degludec and insulin glargine 300, have demonstrated good efficacy and safety with low rates of documented hypoglycemia in this patient population [87][88][89][90]. In the DEVOTE trial, the efficacy and safety of insulin degludec versus insulin glargine 100 was assessed in 7637 patients with T2D at high risk of CV events [87].…”

The Safety and Efficacy of Second-Generation Basal Insulin Analogues in Adults with Type 2 Diabetes at Risk of Hypoglycemia and Use in Other Special Populations: A Narrative Review

“…A number of meta-analyses [ 62 – 64 ], as well as one prospectively designed RCT [ 65 ], post-hoc analyses and RWE [ 42 , 43 , 66 , 67 ], have evaluated the risk of hypoglycemia with second-generation BI analogues in older people, as summarized in Table 1 .…”

“…Several meta-analyses of the EDITION and BEGIN studies have assessed the effectiveness and safety of second-generation BI analogues for the treatment of T2DM in older versus younger subjects [ 35 , 62 – 64 ]. A patient-level meta-analysis of EDITION 1, 2 and 3 revealed that there was a comparable reduction in HbA1c and a lower risk of nocturnal hypoglycemia with Gla-300 versus Gla-100, which was more apparent in the subgroup of subjects aged ≥ 65 years (mean age 69.6 years) than in that aged < 65 years (mean age 54.7 years) (relative risk 0.77, 95% CI 0.68–0.87 vs. 0.70, 95% CI 0.57–0.85, respectively) [ 64 ]. The composite endpoint of the percentage of patients ≥ 65 years reaching HbA1c target (< 7.0 or < 7.5%) at 6 months without confirmed (≤ 3.9 mmol/L [≤ 70 mg/dL] or < 3.0 mmol/L [or < 54 mg/dL]) or severe hypoglycemia at night [00:00–05:59 hours] was significantly higher for Gla-300 versus Gla-100 (all p < 0.05) [ 64 ].…”

“…A patient-level meta-analysis of EDITION 1, 2 and 3 revealed that there was a comparable reduction in HbA1c and a lower risk of nocturnal hypoglycemia with Gla-300 versus Gla-100, which was more apparent in the subgroup of subjects aged ≥ 65 years (mean age 69.6 years) than in that aged < 65 years (mean age 54.7 years) (relative risk 0.77, 95% CI 0.68–0.87 vs. 0.70, 95% CI 0.57–0.85, respectively) [ 64 ]. The composite endpoint of the percentage of patients ≥ 65 years reaching HbA1c target (< 7.0 or < 7.5%) at 6 months without confirmed (≤ 3.9 mmol/L [≤ 70 mg/dL] or < 3.0 mmol/L [or < 54 mg/dL]) or severe hypoglycemia at night [00:00–05:59 hours] was significantly higher for Gla-300 versus Gla-100 (all p < 0.05) [ 64 ]. The percentage of participants experiencing treatment-emergent adverse events (TEAEs) was similar for both insulins (58.4 vs. 56.0% in participants aged ≥ 65 years and 56.9 vs. 52.8% in participants aged < 65 years for Gla-300 and Gla-100, respectively).…”

Effective Initiation and Treatment With Basal Insulin in People With Type 2 Diabetes: Focus on Mitigating Hypoglycemia in Patients at Increased Risk: Executive Summary

“…They also review results of the randomized, pragmatic real-world ACHIEVE Control trial (n 5 3,304), which showed superiority with Gla-300 versus first-generation basal insulin analogs for achievement of a 6-month composite end point of HEDIS (Healthcare Effectiveness Data and Information Set) A1C target attainment without documented symptomatic (#70 mg/dL) or severe (defined as ADA level 3) hypoglycemia at any time of day (22). The authors note that, across several RCTs and real-world studies of people with type 2 diabetes and increased risk for hypoglycemia (e.g., those $65 years of age, with renal impairment, or with CVD) lower rates of hypoglycemia were seen with secondgeneration basal insulin analogs (Gla-300 and IDeg) versus first-generation basal insulin analogs (23)(24)(25)(26)(27) and were consistent with results from RCTs in the overall population with type 2 diabetes.…”