Glargine 300 units/mL reduces nocturnal hypoglycaemia in over 65s

Yale JF, Aroda VR, Charbonnel B et al (2018) 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.Diabetes Metab Oct 23 [Epub ahead of print]

• Older people with type 2 diabetes are at increased risk of hypoglycaemic events and have poorer associated outcomes, such as higher hospitalisation and mortality rates, than younger people with the condition.
• Although the population is ageing and the management of diabetes more complex in older people, there is relatively little evidence available on the safety and efficacy of basal insulin therapy in this patient group. The investigators therefore performed a patient-level meta-analysis comparing the effects of insulin glargine 300 U/mL (Gla-300) with glargine 100 U/mL (Gla-100) in people aged over 65 who have type 2 diabetes.
• Data from the treat-to-target EDITION 1, 2 and 3 trials, in which participants were randomised to receive Gla-100 or Gla-300, were pooled and glycaemic efficacy, hypoglycaemic episodes, adverse events, changes in insulin dose and body weight compared between patients under 65 years and those aged 65 or over.
• Glycaemic control with Gla-100 and Gla-300 was comparable over the 6-month study period in both older (n=662) and younger (n=1,834) participants.
• There were fewer incidences of nocturnal or severe hypoglycaemia in participants receiving Gla-300 compared to those on Gla-100, regardless of age. The reduction in nocturnal hypoglycaemia was greater in older participants, however, with significantly lower rates observed with Gla-300 versus Gla-100 at both glycaemic thresholds measured.
• Serious adverse events relating to treatment were slightly higher in older than younger participants in the three trials (7.5–8.6% versus 4%), highlighting the importance of balancing glycaemic treatment goals with safety in older people with diabetes.
• There was a lower risk of nocturnal hypoglycaemia with Gla-300 compared to Gla-100 in older people with type 2 diabetes, along with glycaemic improvement comparable to that observed in younger people. 
• The authors recommend that, with the increased burden of diabetes and its associated complications in older people, further studies be performed in this patient group to define best treatment approaches.

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