Using a long-acting insulin analog may be a better choice than standard NPH insulin for older adults with type 2 diabetes who are at risk for hypoglycemia (low blood glucose), according to a new study published in the journal JAMA Internal Medicine.
Researchers were interested in whether using long-acting insulin analogs — newer forms of insulin such as Basaglar, Lantus, Levemir and Toujeo — were linked to a lower risk of hospitalization for hypoglycemia compared with an older type of insulin, neutral protamine Hagedorn (NPH). They looked at a group of 575,008 people with type 2 diabetes ages 65 and older, all of whom were U.S. Medicare beneficiaries. Participants all started using their prescribed form of insulin between January 1, 2007, and July 31, 2019, and were followed for a median of 0.37 years (about four months).
Long-acting insulin and hypoglycemia
Overall, insulin glargine (Basaglar, Lantus, Toujeo) was the most commonly prescribed form of insulin, with 407,018 new prescriptions. Next most common was insulin detemir (Levemir) with 141,588 prescriptions, followed by NPH insulin with 26,402 prescriptions. Insulin degludec (Tresiba) was not included in the study.
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The main outcome researchers were interested in was how much time passed, on average, between when a participant started taking insulin and their first emergency room visit or hospitalization for hypoglycemia. They also looked at the risk of recurring hypoglycemia when taking each different type of insulin. Overall, there were 7,347 emergency room visits or hospitalizations for hypoglycemia — 5,194 for insulin glargine, 1,693 for insulin detemir, and 460 for NPH insulin. Based on these numbers, the highest rate of hospitalization was seen in participants who used NPH insulin. In comparison, insulin glargine users were 29% less likely to visit the hospital for hypoglycemia, while insulin detemir users were 28% less likely. The risk reduction for repeated hospital visits was similar for both long-acting insulin analogs.
However, when the researchers looked specifically at participants who took mealtime insulin along with their long-acting insulin or NPH insulin, there was no association between the type of long-acting or NPH insulin they used and the risk of a hospital visit for hypoglycemia. This most likely shows that the hypoglycemia risk linked to taking mealtime insulin is so much greater than the risk linked to long-acting insulin or NPH insulin that in comparison, the type of non-mealtime insulin a person uses is insignificant.
But for older adults with type 2 who don’t take mealtime insulin, this study’s results clearly show that long-acting insulin analogs are likely to be a better choice than NPH insulin for avoiding severe hypoglycemia. Unfortunately, they also tend to be much more expensive than NPH insulin, so many doctors and patients may still decide to prescribe NPH insulin despite the higher hypoglycemia risk.
Want to learn more about insulin? Read “What Does Insulin Do?” and “Insulin Types: Which Is Better for You?” then watch “Injecting Insulin.”
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