Lipska KJ, et al. - In patients with type 2 diabetes, researchers compared the rates of hypoglycemia-related emergency department (ED) visits or hospital admissions related to initiation of long-acting insulin analogs vs human neutral protamine Hagedorn (NPH) insulin. Patients with type 2 diabetes initiating a basal insulin analog vs NPH insulin showed no reduced risk of hypoglycemia-related ED visits or hospital admissions or with improved glycemic control. Findings thereby indicate no clinical advantages of using basal insulin analogs in usual practice settings for these outcomes.

Methods

• From January 1, 2006 through September 30, 2015 researchers performed a retrospective observational study using data from Kaiser Permanente of Northern California.
• They included patients with type 2 diabetes who initiated a long-acting insulin analog or NPH insulin.
• Patients were censored at death, loss of health plan coverage, change in insulin treatment, or study end on September 30, 2015.
• Interventions included initiation of basal insulin analogs (glargine or detemir) vs NPH insulin.
• The time to a hypoglycemia-related ED visit or hospital admission was the primary outcome.
• Change in hemoglobin A1c level within 1 year of insulin initiation was the secondary outcome.

Results

• Researchers identified a total of 25,489 patients with type 2 diabetes who initiated basal insulin therapy (mean age, 60.2 [SD, 11.8] years; 51.9% white; 46.8% female).
• Thirty-nine hypoglycemia-related ED visits or hospital admissions were identified among 1,928 patients who initiated insulin analogs (11.9 events [95% CI, 8.1 to 15.6] per 1,000 person-years) during a mean follow-up of 1.7 years vs 354 hypoglycemia-related ED visits or hospital admissions among 23,561 patients who initiated NPH insulin (8.8 events [95% CI, 7.9 to 9.8] per 1,000 person-years) (between-group difference, 3.1 events [95% CI, -1.5 to 7.7] per 1,000 person-years; P=.07).
• The adjusted hazard ratio of 1.16 (95% CI, 0.71 to 1.78) was noted for hypoglycemia-related ED visits or hospital admissions associated with insulin analog use among 4,428 patients matched by propensity score.
• After initiation of insulin analogs, hemoglobin A1c level decreased from 9.4% (95% CI, 9.3% to 9.5%) to 8.2% (95% CI, 8.1% to 8.2%) and after initiation of NPH insulin, it decreased from 9.4% (95% CI, 9.3% to 9.5%) to 7.9% (95% CI, 7.9% to 8.0%) (adjusted difference-in-differences for glycemic control, -0.22% [95% CI, -0.09% to -0.37%]) within 1 year of insulin initiation.