Efficacy and safety of insulin lispro in geriatric patients with type 2 diabetes: A retrospective analysis of seven randomized controlled clinical trials

摘要

Background and Aims: Glycemic control in geriatric patients with type 2 diabetes (T2DM) remains clinically challenging. The objective of this study was to compare the safety and efficacy of insulin lispro in patients ≥65 years (geriatric) to those 65 years (non-geriatric), using a meta-analysis of randomized controlled clinical trials (RCT). Methods: This is a retrospective analysis of predefined endpoints from an integrated database of seven RCTs of T2DM patients treated with insulin lispro. The primary efficacy measure tested the non-inferiority of insulin lispro (geriatric vs. non-geriatric; non-inferiority margin 0.4%) in terms of hemoglobin A1c (HbA 1c) change from baseline to Month 3 (N = 1,525), with change from baseline to Month 6 as a supportive analysis (N = 885). Changes in HbA 1c from baseline were evaluated with an analysis of covariance model. Secondary measures included incidence and rate of hypoglycemia, and incidence of cardiovascular events. Results: Mean change in HbA1c from baseline to Month 3 was similar for geriatric (-0.97%) and non-geriatric patients (-1.05%); least-square (LS) mean difference (95% CI) was 0.02% (-0.11, 0.15%; p = 0.756). Similar results were observed in patients treated up to Month 6; LS mean difference (95% CI) was 0.07% (-0.12, 0.26%; p = 0.490). Decrease in HbA 1c from baseline to Months 3 and 6 was non-inferior in geriatric compared with non-geriatric patients. There were no significant differences in the incidence and the rate of hypoglycemia, incidence of cardiovascular events, or other serious adverse events including malignancy, post-baseline between the two cohorts. Conclusion: Key measures of efficacy and safety in geriatric patients with T2DM were not significantly different from non-geriatric patients when utilizing insulin lispro. Insulin lispro may be considered a safe and efficacious therapeutic option for the management of T2DM in geriatric patients.