No reduced risk of hypoglycemia-linked ER visits, admissions for basal insulin analog vs. NPH insulin
Initiation of a basal insulin analog versus human neutral protamine Hagedorn (NPH) insulin is not associated with reduction in the risk of hypoglycemia-related emergency department visits or hospital admissions, according to a study published in the July 3 issue of the Journal of the American Medical Association.
Kasia J. Lipska, M.D., from the Yale University School of Medicine in New Haven, Conn., and colleagues compared the rates of hypoglycemia-related emergency department visits or hospital admissions associated with initiation of long-acting insulin analogs versus human NPH insulin in a retrospective observational study. Data were included for 25,489 patients with type 2 diabetes who initiated basal insulin therapy.
The researchers found that there were 39 hypoglycemia-related emergency department visits or hospital admissions among 1,928 patients who initiated insulin analogs, compared with 354 hypoglycemia-related emergency department visits or hospital admissions among 23,561 patients who initiated NPH insulin (11.9 versus 8.8 events per 1,000 person-years) during a mean follow-up of 1.7 years (between-group difference, 3.1 events per 1,000 person-years; 95 percent confidence interval, −1.5 to 7.7; P = 0.07). The adjusted hazard ratio was 1.16 for hypoglycemia-related emergency department visits or hospital admissions associated with insulin analog use among 4,428 patients matched by propensity score. Within one year of insulin initiation, hemoglobin A1c levels decreased from 9.4 to 8.2 percent and from 9.4 to 7.9 percent after initiation of insulin analogs and NPH insulin, respectively.
“The use of basal insulin analogs in usual practice settings may not be associated with clinical advantages for these outcomes,” the authors write.
Two authors disclosed financial ties to the pharmaceutical industry.