Basal Insulin Analogs vs NPH Insulin to Reduce Hypoglycemia-Linked ED Visits in T2D

For patients with type 2 diabetes (T2D), the use of basal insulin analogs does not reduce the risk for hospital admission or hypoglycemia-related emergency department (ED) visits more than human neutral protamine Hagedorn (NPH) insulin, according to research published in JAMA.

Kasia J. Lipska, MD, MHS, of the Department of Internal Medicine at Yale University, and associates conducted a retrospective observational analysis to assess the frequency of hypoglycemia-associated ED and hospital visits as correlated with the use of basal insulin analogs or NPH insulin in patients with T2D.

The primary outcome measured was hypoglycemia-related ED or hospital visits. The secondary outcome measured was change in hemoglobin A_1c levels from baseline to the last measurement obtained up to 1 year after initiating insulin.

The investigators collected data from 25,489 patients with T2D who started a basal insulin analog treatment (average age, 60.2 years; 51.9% white; 46.8% women); 92% of the patients (n=23,561) started with NPH insulin and 8% (n=1928) started with insulin analogs.

During an average follow-up of 1.7 years, there were 309 reported ED visits and 45 hospital admissions linked to hypoglycemia for patients who started with NPH insulin. The average follow-up for patients starting with insulin analogs at baseline was 1.71 years; 32 ED visits and 7 hospital admissions linked to hypoglycemia were reported.

The average initial hemoglobin A_1c levels for patients who started with NPH insulin and insulin analogs were 9.40% and 9.41%, respectively. After one year, hemoglobin A_1c levels decreased by 1.26% and 1.48% for individuals starting with insulin analogs and NPH insulin, respectively.

“Among patients with type 2 diabetes, initiation of a basal insulin analog compared with NPH insulin was not associated with a reduced risk of hypoglycemia-related ED visits or hospital admissions or with improved glycemic control,” the authors concluded. “These findings suggest that the use of basal insulin analogs in usual practice settings may not be associated with clinical advantages for these outcomes.”

Lipska KJ, Parker MM, Moffet HH, Huang ES, Karter AJ. Association of initiation of basal insulin analogs vs neutral protamine Hagedorn insulin with hypoglycemia-related emergency department visits or hospital admissions and with glycemic control in patients with type 2 diabetes [published online June 23, 2018.] JAMA. doi: 10.1001/jama.2018.7993