HbA1c decrease larger with insulin pen vs. syringes for older adults with type 2 diabetes
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Older adults with type 2 diabetes in Brazil using an insulin pen had a lower HbA1c after 24 weeks than those using syringes, according to findings published in Diabetology & Metabolic Syndrome.
Although there was an HbA1c difference between the two groups, researchers noted route of insulin administration did not result in a significant difference in hypoglycemia, quality of life or adherence between the groups.
“Both groups of treatment had significant improvement in glycemic control over 24 weeks,” Rafael Vaz Machry, MD, PhD, a professor in the postgraduate program in medical sciences-endocrinology at Universidade Federal Do Rio Grande Do Sul in Porto Alegre, Brazil, and colleagues wrote. “This result reinforces that insulin, regardless of device used, improves the control.”
Researchers conducted a randomized clinical trial in the endocrinology division of Hospital de Clinicas de Porto Alegre and at Hospital Universitario de Santa Maria in Brazil. Adults aged 60 years or older with type 2 diabetes and an HbA1c of 8.5% or higher over the 3 months before enrollment participated in the trial. Participants were randomly assigned to use an insulin pen (HumaPen Luxura, Eli Lilly) or syringes for insulin applications for a period of 24 weeks. Clinical evaluations were performed monthly during the trial. Adults reported the presence of hypoglycemia, severity of any episodes, symptoms presented and other adverse effects. Blood pressure, weight and height were assessed at each visit. A validated questionnaire was conducted to evaluate quality of life and the impact of diabetes for each participant.
There were 121 older adults who participated in the study, with 61 randomly assigned to the insulin pen group and 60 to the syringe group. No differences in absolute HbA1c were observed between the groups at baseline, 12 weeks or 24 weeks. However, the insulin pen group had a larger decrease in HbA1c at 12 weeks than the syringe group (mean change, –1.53% vs. –0.81%; P = .02). No significant difference in HbA1c from 12 to 24 weeks was observed. For the entire trial period, the insulin pen group had a larger HbA1c reduction than those using syringes (mean change, –1.94% vs. –1.04%; P < .05). Researchers observed no differences in the number of hypoglycemia cases or severity during the trial.
“High levels of HbA1c along the follow-up may have contributed to the low frequency of hypoglycemia in both groups,” the researchers wrote. “Another factor that limited this analysis was the way of measuring hypoglycemia. The episodes were computed if recorded by patients. Unrecorded episodes could not be confirmed.”
There was no significant difference in insulin dose adherence between the two groups. Neither group had a significant increase in BMI during the trial. There was no difference between the two groups in the number of drug classes used in the study or the number of participants using basal-bolus insulin scheme. Although the insulin pen group had a worse quality of life score at baseline compared with the syringe group, there was no significant difference in quality of life at 24 weeks, the researchers wrote.
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