A new variety of long-lasting insulin, called insulin degludec, lowers the risk of nighttime low blood sugar in elderly diabetic adults compared with insulin glargine, a systematic review of diabetes studies has found. The meta-analysis of phase 3 clinical trials will be presented Monday at The Endocrine Society's 94th Annual Meeting in Houston.
"Insulin degludec is a well-tolerated and appropriate therapy for elderly patients with diabetes, who are particularly vulnerable to low blood glucose levels," said the study's lead author Christopher Sorli, MD, chairman of the Department of Diabetes, Endocrinology and Metabolism at Billings Clinic in Billings, Mont.
"Compared with insulin glargine, insulin degludec may offer considerable benefits by reducing the major side effect of insulin therapy, hypoglycemia," Sorli said.
Hypoglycemia, or low blood sugar, occurs often in elderly diabetic patients, especially at night when they are asleep and unable to try to reverse it.
Sorli and the other researchers evaluated the rates of hypoglycemia in 915 patients ages 65 and older who had either Type 1 or Type 2 diabetes. The patients were among more than 4,300 diabetic individuals who participated in one of seven clinical trials that compared insulin degludec with a commercially available insulin (glargine). Insulin degludec is a basal, or long-lasting, injectable insulin that is awaiting approval by the U.S. Food and Drug Administration, according to its manufacturer, Denmark-headquartered Novo Nordisk, which funded this study.
Study participants received treatment once a day for either 26 weeks or 52 weeks. Most patients (632) randomly received insulin degludec, and the other 283 patients randomly received insulin glargine.
Hypoglycemia was defined as a plasma glucose, or blood sugar, level less than 56 milligrams per deciliter or a severe hypoglycemic episode requiring assistance. The rate of hypoglycemia occurring at night was significantly—35 percent—lower in the elderly patients treated with degludec than in those treated with glargine, Sorli said.
In addition, the number of all hypoglycemic episodes was lower in the degludec-treated group than in the glargine-treated group, but this difference was not statistically significant, the investigators reported.
These results in older adults are consistent with previously reported results from the overall adult patient population of these clinical trials, said Sorli, who disclosed that he is a member of Novo Nordisk's speakers bureau and advisory board.
Both insulin degludec and insulin glargine are insulin analogs, which are insulins with modifications to their molecular structures for the purpose of ensuring better therapeutic results. These modifications alter the drug's properties, for example, giving a longer duration of action, which may enable less frequent dosing, Sorli said.
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