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

I.V. Glinkina, A.V. Oderiy, A.P. Galkina, G.Sh. Berdygylydzhova, V.V. Fadeev

I.M. Sechenov First Moscow State Medical University (Sechenov University); Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, Moscow, Russia

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, Cand. Sci. (Med.), Associate Professor, Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; ORCID: https://orcid.org/0000-0001-8505-5526
Anna V. Oderiy, Senior Laboratory Assistant, Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; anya.oderij2112@gmail.com, ORCID: https://orcid.org/0000-0002-1756-1950, eLibrary SPIN: 1825-8303 (corresponding author)
A.P. Galkina, student, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; ORCID: https://orcid.org/0009-0008-0209-9979
G.Sh. Berdygylydzhova, PhD student, Department of Endocrinology No. 1 N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; ORCID: https://orcid.org/0000-0002-0141-6353
V.V. Fadeev, Corresponding Member of RAS, Dr. Sci. (Med.), Professor, Head of the Endocrinology Department No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, Director of the Endocrinology Clinic, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; ORCID: https://orcid.org/0000-0002-3026-6315

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