DIVE/DPV registries: benefits and risks of analog insulin use in individuals 75 years and older with type 2 diabetes mellitus
Introduction The aims of this study were to characterize insulin-treated individuals aged ≥75 years with type 2 diabetes using basal insulin analogs (BIA) or regular insulins (human insulin (HI)/neutral protamine Hagedorn (NPH)) and to compare the benefits and risks.Research design and methods The a...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2021-03-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/9/1/e002215.full |
| _version_ | 1826936610281750528 |
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| author | Peter Bramlage Sascha R Tittel Gesine van Mark Reinhard Welp Jörg Gloyer Stefan Sziegoleit Ralf Barion Peter M Jehle Dieter Erath Stefanie Lanzinger |
| author_facet | Peter Bramlage Sascha R Tittel Gesine van Mark Reinhard Welp Jörg Gloyer Stefan Sziegoleit Ralf Barion Peter M Jehle Dieter Erath Stefanie Lanzinger |
| author_sort | Peter Bramlage |
| collection | DOAJ |
| description | Introduction The aims of this study were to characterize insulin-treated individuals aged ≥75 years with type 2 diabetes using basal insulin analogs (BIA) or regular insulins (human insulin (HI)/neutral protamine Hagedorn (NPH)) and to compare the benefits and risks.Research design and methods The analysis was based on data from the DPV (Diabetes-Patienten-Verlaufsdokumentation) and DIVE (DIabetes Versorgungs-Evaluation) registries. To balance for confounders, propensity score matching for age, sex, diabetes duration, body mass index and hemoglobin A1c (HbA1c) as covariates was performed.Results Among 167 300 patients aged ≥75 years with type 2 diabetes (mean age, 80.3 years), 9601 subjects used insulin regimens with basal insulin (HI/NPH or BIA). Of these 8022 propensity score-matched subjects were identified. The mean diabetes duration was ~12 years and half of the patients were male. At the time of switch, patients provided with BIA experienced more dyslipidemia (89.3% vs 85.9%; p=0.002) and took a greater number of medications (4.3 vs 3.7; p<0.001) and depression was more prevalent (8.4% vs 6.5%; p=0.01). Aggregated to the most actual treatment year, BIA was associated with a higher percentage of patients using basal-supported oral therapy (42.6% vs 14.4%) and intensified conventional insulin therapy (44.3% vs 29.4%) and lower total daily insulin doses (0.24 IU/kg/day vs 0.30 IU/kg/day; p<0.001). The study did not reveal significant differences in efficacy (HbA1c 7.4% vs 7.3%; p=0.06), hospitalizations (0.7 vs 0.8 per patient-year (PY); p=0.15), length of stay (16.3 vs 16.1 days per PY; p=0.53), or rates of severe hypoglycemia (4.07 vs 4.40 per 100 PY; p=0.88), hypoglycemia with coma (3.64 vs 3.26 per 100 PY; p=0.88) and diabetic ketoacidosis (0.01 vs 0.03 per 100 PY; p=0.36).Conclusion BIA were used in more individually and patient-centered therapy regimens compared with HI/NPH in patients with a mean age of 80 years. Both groups were slightly overtreated with mean HbA1c <7.5%. The risk of severe hypoglycemia was low and independent of insulin type. Further analyses of elderly patients with type 2 diabetes are needed to provide evidence for best practice approaches in this age group. |
| first_indexed | 2024-12-19T15:20:44Z |
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| id | doaj.art-ada6db58000c4f9985f7167a9ea4fe8a |
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| issn | 2052-4897 |
| language | English |
| last_indexed | 2025-02-17T18:25:32Z |
| publishDate | 2021-03-01 |
| publisher | BMJ Publishing Group |
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| spelling | doaj.art-ada6db58000c4f9985f7167a9ea4fe8a2024-12-12T19:50:08ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972021-03-019110.1136/bmjdrc-2021-002215DIVE/DPV registries: benefits and risks of analog insulin use in individuals 75 years and older with type 2 diabetes mellitusPeter Bramlage0Sascha R Tittel1Gesine van Mark2Reinhard Welp3Jörg Gloyer4Stefan Sziegoleit5Ralf Barion6Peter M Jehle7Dieter Erath8Stefanie Lanzinger9Institut für Pharmakologie und Präventive Medizin GmbH, Cloppenburg, GermanyInstitute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, GermanyInstitute for Pharmacology and Preventive Medicine, Cloppenburg, GermanyDepartment of Internal Medicine, Knappschaftskrankenhaus Bottrop, Bottrop, GermanyCenter for Diabetes Ludwigsburg, Ludwigsburg, GermanySpecialized Diabetes Practice Berlin Tempelhof, Berlin, GermanyMedical Practice for Internal Medicine and Diabetology Rhein-Sieg, Niederkassel-Rheidt, GermanyDepartment of Internal Medicine I, Martin-Luther-University Halle-Wittenberg, University Medicine, Academic Hospital Paul-Gerhardt-Stift, Lutherstadt Wittenberg, GermanyMedical Practice for Internal Medicine Rottweil, Rottweil, GermanyInstitute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, GermanyIntroduction The aims of this study were to characterize insulin-treated individuals aged ≥75 years with type 2 diabetes using basal insulin analogs (BIA) or regular insulins (human insulin (HI)/neutral protamine Hagedorn (NPH)) and to compare the benefits and risks.Research design and methods The analysis was based on data from the DPV (Diabetes-Patienten-Verlaufsdokumentation) and DIVE (DIabetes Versorgungs-Evaluation) registries. To balance for confounders, propensity score matching for age, sex, diabetes duration, body mass index and hemoglobin A1c (HbA1c) as covariates was performed.Results Among 167 300 patients aged ≥75 years with type 2 diabetes (mean age, 80.3 years), 9601 subjects used insulin regimens with basal insulin (HI/NPH or BIA). Of these 8022 propensity score-matched subjects were identified. The mean diabetes duration was ~12 years and half of the patients were male. At the time of switch, patients provided with BIA experienced more dyslipidemia (89.3% vs 85.9%; p=0.002) and took a greater number of medications (4.3 vs 3.7; p<0.001) and depression was more prevalent (8.4% vs 6.5%; p=0.01). Aggregated to the most actual treatment year, BIA was associated with a higher percentage of patients using basal-supported oral therapy (42.6% vs 14.4%) and intensified conventional insulin therapy (44.3% vs 29.4%) and lower total daily insulin doses (0.24 IU/kg/day vs 0.30 IU/kg/day; p<0.001). The study did not reveal significant differences in efficacy (HbA1c 7.4% vs 7.3%; p=0.06), hospitalizations (0.7 vs 0.8 per patient-year (PY); p=0.15), length of stay (16.3 vs 16.1 days per PY; p=0.53), or rates of severe hypoglycemia (4.07 vs 4.40 per 100 PY; p=0.88), hypoglycemia with coma (3.64 vs 3.26 per 100 PY; p=0.88) and diabetic ketoacidosis (0.01 vs 0.03 per 100 PY; p=0.36).Conclusion BIA were used in more individually and patient-centered therapy regimens compared with HI/NPH in patients with a mean age of 80 years. Both groups were slightly overtreated with mean HbA1c <7.5%. The risk of severe hypoglycemia was low and independent of insulin type. Further analyses of elderly patients with type 2 diabetes are needed to provide evidence for best practice approaches in this age group.https://drc.bmj.com/content/9/1/e002215.full |
| spellingShingle | Peter Bramlage Sascha R Tittel Gesine van Mark Reinhard Welp Jörg Gloyer Stefan Sziegoleit Ralf Barion Peter M Jehle Dieter Erath Stefanie Lanzinger DIVE/DPV registries: benefits and risks of analog insulin use in individuals 75 years and older with type 2 diabetes mellitus BMJ Open Diabetes Research & Care |
| title | DIVE/DPV registries: benefits and risks of analog insulin use in individuals 75 years and older with type 2 diabetes mellitus |
| title_full | DIVE/DPV registries: benefits and risks of analog insulin use in individuals 75 years and older with type 2 diabetes mellitus |
| title_fullStr | DIVE/DPV registries: benefits and risks of analog insulin use in individuals 75 years and older with type 2 diabetes mellitus |
| title_full_unstemmed | DIVE/DPV registries: benefits and risks of analog insulin use in individuals 75 years and older with type 2 diabetes mellitus |
| title_short | DIVE/DPV registries: benefits and risks of analog insulin use in individuals 75 years and older with type 2 diabetes mellitus |
| title_sort | dive dpv registries benefits and risks of analog insulin use in individuals 75 years and older with type 2 diabetes mellitus |
| url | https://drc.bmj.com/content/9/1/e002215.full |
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