Glargine-300 might be preferable for older people with type 2 diabetes
medwireNews: Analysis of older participants in the BRIGHT trial suggests that this subgroup may do slightly better with insulin glargine-300 than with degludec.
There were 929 people with type 2 diabetes in BRIGHT. The investigators’ pre-planned analysis of the 333 participants aged 65 years or older showed similar performance of insulin glargine-300 and insulin degludec in this subgroup.
But their post-hoc analysis of the 161 people who were at least 70 years old detected the possibility of better outcomes in those randomly assigned to receive glargine-300 rather than degludec.
Specifically, the improvement in glycated hemoglobin (HbA1c) during 24 weeks of treatment was marginally less with glargine-300 than degludec in the under 70s, by a least squares mean of 0.02%.
But people aged 70 years or more achieved a significantly greater reduction with glargine-300 than degludec, by a least squares mean of 0.34%.
However, there was no significant difference between the treatments in the proportion of people achieving their HbA1c targets in either age category.
There was no overall difference in hypoglycemia rates during the study, although there was a slightly lower rate with glargine-300 versus degludec during the titration phase. This was seen for both the 65 years or older and the 70 years or older subgroups and was in line with the previously reported findings in the overall study population.
“These results suggest that [glargine]-300 may provide an effective therapy option in older people who are at higher risk of hypoglycaemia and its consequences,” write Geremia Bolli (Perugia University Medical School, Italy) and co-researchers in Diabetes, Obesity and Metabolism.
Previous findings from BRIGHT indicated that people with a reduced estimated glomerular filtration rate (eGFR) might have better outcomes with glargine-300 than degludec. As eGFR was generally lower in older participants, the researchers adjusted for this factor to ensure that it was not driving the improved HbA1c reduction with glargine-300 in the older age group.
They report that this adjustment “slightly attenuated” the treatment difference in HbA1c reduction in people aged 70 years or more, making the test for heterogeneity “nominally non-significant,” at p=0.073, but “did not change the overall conclusion.”
Nonetheless, they note the study limitations, including multiple subgroup analyses and small participant numbers, particularly for people aged 70 years or more, and stress that the “results of these post hoc analyses should be interpreted appropriately.”
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