Simplification of insulin regimen in older adults and risk of hypoglycemia
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This case series describes HbA1c levels and frequency of hypoglycemia among older patients with type 2 diabetes whose treatment regimen was simplified to once-a-day glargine with or without noninsulin agents.
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Multiple trials have shown that deintensification of diabetes treatment can be achieved successfully and safely.
“Multiple trials have shown that deintensification of diabetes treatment can be achieved successfully and safely (66)(67)(68)(69).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [66]
The Methods and Results describe one single-arm study in older adults with type 2 diabetes: insulin-regimen simplification reduced hypoglycemia without worsening overall HbA1c. That supports this citation as an example of successful deintensification, but the paper alone does not establish the broader claim about multiple trials or diabetes treatment generally. The accompanying commentary also calls the evidence preliminary because the study was small and had no concurrent control group. (LLM, conf=0.83)
Experimental — accuracy not yet measuredSimplification of the insulin plan to match an individual's self-management abilities and available social and medical support reduces hypoglycemia and disease-related distress without worsening glycemic outcomes.
“Simplification of the insulin plan to match an individual's self-management abilities and their available social and medical support in these situations has been shown to reduce hypoglycemia and diseaserelated distress without worsening glycemic outcomes (100-103).”
From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [102]
The Results (page unavailable) report less hypoglycemia and diabetes-related distress after simplification, with no overall change in HbA1c, in 65 older adults with type 2 diabetes. The Methods describe an insulin-switching algorithm, but do not say the plan was tailored to each person's self-management abilities or available social and medical support. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSimplification of the insulin plan to match an individual's self-management abilities and their available social and medical support reduces hypoglycemia and disease-related distress without worsening glycemic outcomes.
“Simplification of the insulin plan to match an individual's self-management abilities and their available social and medical support in these situations has been shown to reduce hypoglycemia and disease-related distress without worsening glycemic outcomes (107-110).”
From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [109]
The Results report less hypoglycemia and diabetes-related distress after simplification, with no overall change in HbA1c, among 65 older adults with type 2 diabetes (page not provided). The Methods describe a regimen-switching algorithm, but do not say it was tailored to each person’s self-management abilities or available social and medical support. The study was also single-arm, so its findings are less definitive than the phrase “has been shown” may imply. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSimplification of the insulin plan to match an individual's self-management abilities and available social and medical support is associated with reduced hypoglycemia and disease-related distress without worsening glycemic outcomes.
“Studies suggest that simplification of the insulin plan to match an individual’s self-management abilities and their available social and medical support is associated with reduced hypoglycemia and disease-related distress without worsening glycemic outcomes”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [151]
The Conclusions and Results report reduced hypoglycemia and diabetes-related distress without an overall worsening of glycemic control after insulin-regimen simplification in older adults. The paper does not establish that the regimen was tailored to each person’s self-management abilities or available social and medical support; its Methods describe a simplification algorithm instead. (LLM, conf=0.86)
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References 6 · Cited by 124
- Authors
- Munshi, M. N., Slyne, C., Segal, A. R., Saul, N., Lyons, C., & Weinger, K.
- Affiliations
- Joslin Diabetes Center (US)
- Corresponding author
- Munshi, Medha N.
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2016-07-01
- Volume
- 176
- Issue
- 7
- Pages
- 1023
- ISSN
- 2168-6106 (ISSN-L)
- OpenAlex
- W2411033625
- Cited by
- 124
- References
- 6
- Citations by year
- 2026: 4 · 2025: 13 · 2024: 15 · 2023: 13 · 2022: 11 · 2021: 10 · 2020: 18 · 2019: 15 · 2018: 12 · 2017: 10 · 2016: 3
- FWCI
- 13.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Robert Wood Johnson Foundation
- Eli Lilly and Company
- Sanofi
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- hypoglycemia, type 2 diabetes, older adults, glargine, basal insulin, HbA1c, glycemic control
- MeSH terms
- Insulin Glargine, Aged, Aged, 80 and over, Diabetes Mellitus, Type 2, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Blood Glucose Self-Monitoring, Treatment Outcome
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