Deintensification of insulin therapy in elderly patients with type 2 diabetes mellitus: impact on glycemic control and risk of hypoglycemia

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Abstract

Objective. Evaluation of the impact of deintensification of the basal-bolus insulin therapy (BBIT) regimen and premixed insulin therapy (PMIT) in elderly patients with type 2 diabetes mellitus (DM2) on glycemic control, hypoglycemic events, functional and cognitive status.

Methods. A prospective, observational, uncontrolled study included 44 DM2 patients (Me age 70.5 [67–75] years) on BBIT or PMIT in combination with oral hypoglycemic agents or glucagon-like peptide-1 receptor agonists (PMIT +/- OHA/GLP-1RA) who discontinued bolus insulin and continued therapy with basal insulin preparations in combination with AHA and/or GLP-1 AR. An examination according to the algorithms for providing medical care to diabetic patients and comprehensive geriatric assessment were conducted.

Results. After deintensification of insulin therapy, the insulin dose decreased from 58 U [47–75] to 31 U [22–50] (p=0.001), the HbA1c level did not change: 8.7 [7.7–10.2]% vs. 8.8 [7.9–10.1]% (p=0.542). The proportion of patients experiencing mild hypoglycemia decreased from 67.6% to 32.6% (p=0.003), the frequency of mild hypoglycemia decreased from 1 [0–4] to 0 [0–2] per 1 patient (p=0.001). BMI decreased from 31.2 kg/m2 [27.55–36.75] to 30.5 kg/m2 [26.25–35.65] (p=0.005). The time to complete the Stand and Go test decreased from 10.6 sec [8.5–12.0] to 8.0 sec [7.0–9.0] (p=0.02). The proportion of patients with risk of falls decreased from 54.3% to 17.1% (p=0.02). The functional and cognitive status of patients did not change.

Conclusions. Deintensification of insulin therapy by discontinuing bolus insulin in elderly patients with type 2 diabetes mellitus reduced the incidence of hypoglycemic events without worsening glycemic control, led to weight loss, and was associated with an increase in walking speed and a decrease in the risk of falls.

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About the authors

I. V. Glinkina

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: anya.oderij2112@gmail.com
ORCID iD: 0000-0001-8505-5526

Cand. Sci. (Med.), Associate Professor, Department of Endocrinology No. 1, Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine

Russian Federation, Moscow

Anna V. Oderiy

I.M. Sechenov First Moscow State Medical University (Sechenov University);

Author for correspondence.
Email: anya.oderij2112@gmail.com
ORCID iD: 0000-0002-1756-1950
SPIN-code: 1825-8303

Senior Laboratory Assistant, Department of Endocrinology No. 1, Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine

Russian Federation, Moscow

A. P. Galkina

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: anya.oderij2112@gmail.com
ORCID iD: 0009-0008-0209-9979

student, Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine

Russian Federation, Moscow

G. Sh. Berdygylydzhova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: anya.oderij2112@gmail.com
ORCID iD: 0000-0002-0141-6353

PhD student, Department of Endocrinology No. 1, Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine

Russian Federation, Moscow

V. V. Fadeev

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: anya.oderij2112@gmail.com
ORCID iD: 0000-0002-3026-6315

Corresponding Member of RAS, Dr. Sci. (Med.), Professor, Head of the Endocrinology Department No. 1, Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine

Russian Federation, Moscow

References

  1. Дедов И.И., Шестакова М.В., Викулова О.К. и др. Сахарный диабет в Российской Федерации: динамика эпидемиологических показателей по данным Федерального регистра сахарного диабета за период 2010–2022 гг. Сахарный диабет. 2023;26(2):104–123. [Dedov I.I., Shestakova M.V., Vikulova O.K., et al. Diabetes mellitus in the Russian Federation: dynamics of epidemiological indicators according to the Federal Register of Diabetes Mellitus for the period 2010–2022. Diabetes mellitus. 2023;26(2):104–123. (In Russ.)]. doi: 10.14341/DM13035.
  2. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. Под ред. Дедова И.И., Шестаковой М.В., Майорова А.Ю. 11-й выпуск. М.; 2023. [Algorithms of specialized medical care for patients with diabetes mellitus. Edited by I.I. Dedov, M.V. Shestakova, A.Yu. Mayorov. 11th issue. M., 2023. (In Russ.)]. doi: 10.14341/DM13042.
  3. Глинкина И.В., Балашова А.В., Шыман А.С., и др. Факторы, определяющие клиническую значимость ингибиторов дипептидилпептидазы-4 в терапии пациентов с сахарным диабетом II типа пожилого возраста. Медицинский Совет. 2021;(7):56–67. [Glinkina I.V., Balashova A.V., Shyman A.S., et al. Factors determining the clinical significance of dipeptidyl peptidase-4 inhibitors in the treatment of elderly patients with type 2 diabetes mellitus. Medical Council. 2021;(7):56–67. (In Russ.)]. doi: 10.21518/2079-701X-2021-7-56-67.
  4. Farrell B., Black C., Thompson W., et al. Deprescribing antihyperglycemic agents in older persons: Evidence-based clinical practice guideline. Can Fam Physician. 2017;63(11):832–843.
  5. Garber A.J. Treat-to-target trials: uses, interpretation and review of concepts. Diabetes Obes Metab. 2014;16(3):193–205. doi: 10.1111/dom.12129.
  6. Остроумова О.Д., Стародубова А.В., Дё В.А. и др. Гипогликемии у пациентов пожилого и старческого возраста с сахарным диабетом II типа: возможные риски и пути профилактики. Профилактическая медицина. 2019;22(1):109–117. [Ostroumova O.D., Starodubova A.V., De V.А., et al. Hypoglycemias in elderly patients with type 2 diabetes mellitus: possible risks and ways to prevent them. The Russian Journal of Preventive Medicine. 2019;22(1):109–117. (In Russ.)]. doi: 10.17116/profmed201922011109.
  7. Гериатрия. Под ред. Ткачевой О.Н., Фроловой Е.В., Яхно Н.Н. Москва: ГЭОТАР-Медиа, 2019. 608 с. [Geriatrics. Ed. by Tkacheva O.N., Frolova E.V., Yakhno N.N. Moscow: GEOTAR-Media, 2019. 608 p. (In Russ.)].
  8. Шарашкина Н.В., Ткачева О.Н., Рунихина Н.К. и др. Комплексная гериатрическая оценка – основной инструмент работы врача-гериатра. Российский журнал гериатрической медицины. 2022;4(12):210–227. [Sharashkina N.V., Tkacheva O.N., Runikhina N.K., et al. Comprehensive geriatric assessment is the main tool of a geriatrician. Russian Journal of Geriatric Medicine. 2022;4(12):210–227. (In Russ.)]. doi: 10.37586/2686-8636-4-2022-210-227.
  9. Ткачева О.Н., Маев И.В., Сычев Д.А. и др. Депрескрайбинг ингибиторов протонной помпы у пациентов пожилого и старческого возраста. Проект протокола. Версия 2.0. от 14 мая 2019. [Tkacheva O.N., Maev I.V., Sychev D.A. et al. Deprescribing of proton pump inhibitors in elderly and senile patients. Draft protocol Version 2.0. dated May 14, 2019 (In Russ.)]. URL: http://www.rgnkc.ru/images/pdf_documets/Protokol_Depreskraibing.pdf.
  10. Rodriguez P., Breslaw N., Xiao H., et al. De-intensification of basal-bolus therapy by replacing prandial insulin with once-weekly subcutaneous semaglutide in individuals with well-controlled type 2 diabetes: A single-centre, open-label randomised trial (TRANSITION-T2D). Diabetes Obes Metab. 2024;(October 2024):642–651. doi: 10.1111/dom.16057.
  11. Giugliano D., Longo M., Caruso P., et al. Feasibility of simplification from a basal-bolus insulin regimen to a fixed-ratio formulation of basal insulin plus a GLP-1RA or to basal insulin plus an SGLT2 inhibitor: BEYOND, a randomized, pragmatic trial. Diabetes Care. 2021;44(6):1353–1360. doi: 10.2337/dc20-2623.
  12. Munshi M.N, Slyne C., Segal A.R., et al. Simplification of insulin regimen in older adults and risk of hypoglycemia. JAMA Intern Med. 2016;176(7):1023–1025. doi: 10.1001/jamainternmed.2016.2288.
  13. Балашова А.B., Глинкина И.В., Павлова М.Т. и др. Особенности терапевтического обучения пожилых пациентов с сахарным диабетом II типа. Медицинский Совет. 2022;(10):22–32. [Balashova A.V., Glinkina I.V., Pavlova M.G., et al. Special considerations in the therapeutic education of elderly with diabetes mellitus type 2. Meditsinskiy Sovet. 2022;16(10):22–32. (In Russ.)]. doi: 10.21518/2079-701X-2022-16-10-22-32.

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