Target attainment in insulin-naive patients at high risk for hypoglycemia: Results from ACHIEVE Control

• Published in: Journal of diabetes and its complications Vol. 35; no. 4; p. 107831
• Main Authors: Anderson, John, Meneghini, Luigi, Hinnen, Debbie, Gill, Jasvinder, Coudert, Mathieu, Evenou, Pierre, Munshi, Medha
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2021; Elsevier Limited
• Subjects: Age; Aged; Basal insulin; Blood Glucose; Cardiovascular disease; Cognitive ability; Dementia; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Drug dosages; Glucose; Glycated Hemoglobin A - analysis; Heart attacks; Heart failure; Humans; Hypoglycemia; Hypoglycemia - chemically induced; Hypoglycemia - epidemiology; Hypoglycemia - prevention & control; Hypoglycemic Agents - adverse effects; Insulin; Insulin Glargine; Insulin, Regular, Human; Kidney diseases; Patients; Risk factors; Type 2 diabetes; Type 2 diabetes; Basal insulin; Insulin glargine; Hypoglycemia; Risk factors
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2020.107831

To better understand outcomes in people with type 2 diabetes at high risk of hypoglycemia, we conducted post hoc analyses in subgroups of participants from the real-world ACHIEVE Control study (NCT02451137) with ≥1 hypoglycemia risk factor.
Insulin-naive adults with type 2 diabetes and A1c ≥8% were randomized 1:1 to insulin glargine 300 U/mL (Gla-300) or standard-of-care basal insulin (SOC-BI). Participants had documented history of ≥1 risk factors for hypoglycemia: chronic kidney disease, cardiovascular disease, dementia or blindness, age ≥65 years, or history of hypoglycemia. Outcomes included individualized A1c target attainment without documented symptomatic hypoglycemia (blood glucose [BG] ≤3.9 mmol/L or <3.0 mmol/L) or severe hypoglycemia, A1c target attainment, and absence of documented symptomatic or severe hypoglycemia at 6 and 12 months.
Within subgroups, odds ratios generally showed trends favoring Gla-300 versus SOC-BI, particularly for hypoglycemia avoidance in participants ≥65 years of age (BG ≤3.9 mmol/L; odds ratio, 1.52; 95% confidence interval, 1.14–2.03) and those with chronic kidney disease (BG ≤3.9 mmol/L; odds ratio, 2.28; 95% confidence interval, 1.26–4.12). Results were consistent with the overall population.
These data suggest potential benefit of Gla-300 versus SOC-BI for avoiding hypoglycemia in participants with ≥1 hypoglycemia risk factor.
•Minimizing the risk of hypoglycemia is important when initiating basal insulin (BI).•ACHIEVE Control evaluated Gla-300 vs standard-of-care first-generation BI (SOC-BI).•We performed a post hoc analysis in patients with ≥1 hypoglycemia risk factor.•Trends generally favored Gla-300 vs SOC-BI for avoiding hypoglycemia.•Results were consistent with the overall ACHIEVE Control population.