Insulin initiation in elderly patients with type 2 diabetes in France: a subpopulation of the LIGHT study

Abstract

Objective:

To examine the management of basal insulin analogue initiation in combination with oral antidiabetic drug (OAD) therapy in elderly patients with type 2 diabetes (aged ≥70 years) by physicians via comparison to the same treatment strategy in younger individuals (<70 years).

Methods:

This subanalysis of a longitudinal observational study took place in a clinical setting across 761 health centres in France. A total of 1802 patients with type 2 diabetes (519 aged ≥70 years and 1283 aged <70 years) participated. The primary endpoint of this study was to assess the management of basal insulin analogue initiation along with OADs in elderly patients (aged ≥70 years) by physicians. Secondary endpoints included HbA_1c, percentage of patients achieving HbA_1c target (<7.0%), fasting plasma glucose, weight change (kg) and hypoglycaemia.

Results:

The initial mean (standard deviation [SD]) basal insulin analogue dose was similar in the elderly and younger patient subgroups (0.18 [0.09] IU/kg vs. 0.18 [0.11] IU/kg, respectively; not significant [NS]). The mean (SD) number of injections per day was also comparable between age groups (1 [0.2] per day vs. 1 [0.3] per day, respectively for elderly and younger patients; NS). Three months after initiation of long-acting insulin analogue therapy, 3.5% (n = 18) of elderly patients ceased insulin treatment. At study end, the mean (SD) HbA_1c for elderly patients was 7.6% (0.9%), and for younger patients it was 7.5% (0.9%). Also, the rate of overall hypoglycaemia was comparable in the elderly and younger patients (0.38 [1.2] events/patient/month vs. 0.35 [1.0] events/patient/month, respectively; NS). Limitations of this study include the possibility of inaccurate patient recall of hypoglycaemic events and deficiencies in the adverse events reporting system.

Conclusion:

Basal insulin analogues were successfully initiated in elderly patients in combination with OAD therapies and were shown to provide effective glycaemic control. Levels of hypoglycaemia were also similar to those seen in younger patients.

Key words::

• Basal insulin
• Elderly
• Initiation
• Type 2 diabetes

Transparency

Declaration of funding

This manuscript was sponsored by Novo Nordisk Pharmaceutique.

Declaration of financial/other relationships

J.D. has received grant support from Novo Nordisk and Merck Serono, and consultancy fees from BMS, AstraZeneca, GSK and Becton-Dickinson. N.L. is an employee of Novo Nordisk. V.K. has received consultancy fees from Boehringer-Ingelheim, Lilly, Novo Nordisk and Sanofi. She is also a stock shareholder with Novo Nordisk and has received grants from Novo Nordisk for a clinical trial. B.V. has received consultancy fees and honoraria for lectures from AstraZeneca/Bristol-Myers Squibb, Bayer Pharma, Lilly, Merck Sharp & Dohme-Chibret, Novartis Pharma Novo Nordisk, Sanofi, Servier and Takeda. C.T. has received a research grant from Novo Nordisk and honoraria for lectures from Novartis Pharma, AstraZeneca/Bristol-Myers Squibb and Lilly.

CMRO peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgements

The authors would like to thank Watermeadow Medical for their editorial assistance in developing this manuscript, supported by Novo Nordisk Pharmaceutique.