Observational Study of Once-Daily Insulin Detemir in People with Type 2 Diabetes Aged 75 Years or Older A Sub-Analysis of Data from the Study of Once-Daily Levemir (SOLVE)

• Published in: Drugs & aging Vol. 30; no. 3; pp. 167 - 175
• Main Authors: Karnieli, Eddy, Baeres, Florian M. M., Dzida, Grzegorz, Ji, Qiuhe, Ligthelm, Robert, Ross, Stuart, Svendsen, Anne Louise, Yale, Jean-François
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing AG 01.03.2013; Adis International; Springer Nature B.V
• Subjects: Age groups; Aged; Antidiabetics; Biological and medical sciences; Blood Glucose - analysis; Clinical medicine; Diabetes; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Geriatrics/Gerontology; Glucose; Glycated Hemoglobin A - analysis; Health care expenditures; Hemoglobin; Hormones. Endocrine system; Humans; Hypoglycemia; Hypoglycemia - chemically induced; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - adverse effects; Insulin; Insulin Detemir; Insulin, Long-Acting - administration & dosage; Insulin, Long-Acting - adverse effects; Internal Medicine; Life expectancy; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Observational studies; Older people; Original; Original Research Article; Patients; Pharmacology. Drug treatments; Pharmacology/Toxicology; Pharmacotherapy; United Kingdom > UK; United States > US; Hypoglycaemic Episode; Insulin Detemir; Sulphonylurea; Tight Glycaemic Control; Severe Hypoglycaemia; Endocrinopathy; Type 2 diabetes; Human; Data analysis; Drug combination; Insulin detemir; Oral administration; Metabolic diseases; Review; Hypoglycemic agent; Treatment; Single daily dose; Elderly
• ISSN: 1170-229X; 1179-1969
• DOI: 10.1007/s40266-013-0054-3

Objectives Older patients are particularly vulnerable to hypoglycaemia. The aim of this study was to evaluate the response to initiation of once-daily insulin detemir in patients aged ≥75 years with type 2 diabetes mellitus (T2DM) treated with one or more oral antidiabetic drugs (OADs). Methods A sub-analysis was conducted using data from SOLVE (Study of Once daily LeVEmir), a 24-week observational study involving 3,219 investigators and 2,817 project sites from ten countries. Routine clinical practice was followed; there were no study-prescribed procedures. The total cohort comprised 17,374 participants, of whom 2,398 (14 %) were aged ≥75 years. The physicians collected information from patient recall, the patients’ medical records and their self-monitored blood glucose diaries (if kept). Results Pre-insulin glycated haemoglobin (HbA 1c ) was similar between participants aged ≥75 years and those aged <75 years (HbA 1c 8.8 ± 1.5 % vs. 8.9 ± 1.6 % [mean ± SD], respectively). After 24 weeks of treatment, similar reductions in HbA 1c were observed in the two subgroups: 7.6 ± 1.1 % and 7.5 ± 1.2 % in participants aged ≥75 years and those aged <75 years, respectively. The incidence of severe hypoglycaemia (episodes per patient-year) decreased during the study in both age groups (from 0.057 to 0.007 in patients aged ≥75 years; from 0.042 to 0.005 in patients aged <75 years), while minor hypoglycaemia increased from 1.1 to 2.0 and from 1.7 to 1.8 episodes per patient-year in the older and younger age groups, respectively. Average weight reduction was similar in both groups: −0.5 kg (≥75 years) and −0.6 kg (<75 years). Conclusion In both the older and younger age groups, the addition of once-daily insulin detemir to existing OAD regimens was effective and safe. In older patients, an improvement in HbA 1c of 1.2 % was not associated with an increased risk of severe hypoglycaemia or weight gain.