Insulin initiation in elderly patients with type 2 diabetes in France: a subpopulation of the LIGHT study

Objective: To examine the management of basal insulin analogue initiation in combination with oral antidiabetic drug (OAD) therapy in elderly patients with type 2 diabetes (aged >= 70 years) by physicians via comparison to the same treatment strategy in younger individuals (<70 years). Methods: This subanalysis of a longitudinal observational study took place in a clinical setting across 761 health centres in France. A total of 1802 patients with type 2 diabetes (519 aged >= 70 years and 1283 aged <70 years) participated. The primary endpoint of this study was to assess the management of basal insulin analogue initiation along with OADs in elderly patients (aged >= 70 years) by physicians. Secondary endpoints included HbA(1c), percentage of patients achieving HbA(1c) target (<7.0%), fasting plasma glucose, weight change (kg) and hypoglycaemia. Results: The initial mean (standard deviation [SD]) basal insulin analogue dose was similar in the elderly and younger patient subgroups (0.18 [0.09] IU/kg vs. 0.18 [0.11] IU/kg, respectively; not significant [NS]). The mean (SD) number of injections per day was also comparable between age groups (1 [0.2] per day vs. 1 [0.3] per day, respectively for elderly and younger patients; NS). Three months after initiation of long-acting insulin analogue therapy, 3.5% (n=18) of elderly patients ceased insulin treatment. At study end, the mean (SD) HbA(1c) for elderly patients was 7.6% (0.9%), and for younger patients it was 7.5% (0.9%). Also, the rate of overall hypoglycaemia was comparable in the elderly and younger patients (0.38 [1.2] events/patient/month vs. 0.35 [1.0] events/patient/month, respectively; NS). Limitations of this study include the possibility of inaccurate patient recall of hypoglycaemic events and deficiencies in the adverse events reporting system. Conclusion: Basal insulin analogues were successfully initiated in elderly patients in combination with OAD therapies and were shown to provide effective glycaemic control. Levels of hypoglycaemia were also similar to those seen in younger patients.