Comparison of Safety and Efficacy of Insulin Glargine and Neutral Protamine Hagedorn Insulin in Older Adults with Type 2 Diabetes Mellitus: Results from a Pooled Analysis
Open accessAbstract
Objectives: To compare the safety and efficacy of adding insulin glargine or neutral protamine Hagedorn ( NPH ) insulin to existing oral antidiabetic drug ( OAD ) regimens in adults with type 2 diabetes mellitus. Design: Pooled analysis of data from five randomized controlled trials with similar designs. Setting: Three hundred forty‐two centers in more than 30 countries worldwide. Participants: Randomly selected individuals aged ≤ 80 with a body mass index ≤ 40 kg/m 2 and a glycosylated hemoglobin ( HbA1c ) level of 7.5% to 12.0%. Measurements: Fixed‐ and random‐effects models were used to compare outcomes after 24 or 28 weeks of treatment (insulin glargine, n = 1,441; NPH insulin, n = 1,254) according to age (≥65, n = 604 vs < 65, n = 2,091) and age based on treatment (e.g., ≥65 receiving insulin glargine vs NPH insulin). Outcomes included change in HbA1c , fasting blood glucose ( FBG ), insulin dose, and hypoglycemia incidence and event rates. Results: At end point, participants aged 65 and older receiving insulin glargine had greater reductions in HbA1c and FBG than those receiving similar doses of NPH insulin. In contrast, for participants younger than 65, there were no statistically significant differences in reductions in HbA1c or FBG between insulin glargine and NPH insulin. Daytime hypoglycemia rates were similar in all groups, although the rates of nocturnal symptomatic and severe hypoglycemia were lower with insulin glargine than NPH insulin. Conclusion: Addition of insulin glargine to oral antidiabetic drugs in older adults with poor glycemic control may have modestly better glycemic benefits than adding NPH insulin, with low risk of hypoglycemia.
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Addition of long-acting insulin was similarly effective in achieving A1C goals for older patients with type 2 diabetes (mean age 69 years) in a series of trials, with no greater rates of hypoglycemia than in younger patients (mean age 53 years).
“Addition of long-acting insulin was similarly effective in achieving A1C goals for older patients with type 2 diabetes (mean age 69 years) in a series of trials, with no greater rates of hypoglycemia than in younger patients (mean age 53 years)100.”
From Diabetes in Older Adults: A Consensus Report (2012) · cites this paper as [100]
Insulin therapy can be used to achieve glycemic goals in selected older adults with type 2 diabetes with similar efficacy and hypoglycemia risk as in younger patients.
“Insulin therapy can be used to achieve glycemic goals in selected older adults with type 2 diabetes with similar efficacy and hypoglycemia risk as in younger patients.”
From Diabetes in Older Adults: A Consensus Report (2012) · cites this paper as [100]
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- Authors
- Lee, P., Chang, A., Blaum, C., Vlajnic, A., Gao, L., & Halter, J.
- Affiliations
- University of Michigan (US)
- Sanofi (United States) (US)
- VA Ann Arbor Healthcare System (US)
- Corresponding author
- Lee, Pearl
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2012-01
- Volume
- 60
- Issue
- 1
- Pages
- 51-59
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W2043231410
- Cited by
- 50
- References
- 42
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 2 · 2021: 3 · 2020: 4 · 2019: 4 · 2018: 3 · 2017: 4 · 2016: 4 · 2015: 4 · 2014: 7 · 2013: 5 · 2012: 7
- FWCI
- 5.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- 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 › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- insulin glargine, neutral protamine Hagedorn insulin, type 2 diabetes, older adults, glycemic control, HbA1c, fasting blood glucose, hypoglycemia, nocturnal hypoglycemia, insulin dose, oral antidiabetic drugs, long-acting insulin
- MeSH terms
- Insulin Glargine, Adult, Age Factors, Aged, Aged, 80 and over, Blood Glucose, Diabetes Mellitus, Type 2, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Isophane, Male, Middle Aged, Prospective Studies, Global Health, Body Mass Index, Incidence, Treatment Outcome, Age Distribution, Insulin, Long-Acting
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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