Glycaemic control and hypoglycaemia risk with insulin glargine 300 U/mL and insulin degludec 100 U/mL in older participants in the BRIGHT trial

Aim To evaluate the efficacy and safety of insulin glargine 300 U/mL (Gla-300) versus insulin degludec 100 U/mL (IDeg-100) in predefined (</>= 65 years) and post hoc (</>= 70 years) age groups of people with type 2 diabetes (T2D) in the BRIGHT trial. Materials and Methods BRIGHT was the first head-to-head randomized trial comparing Gla-300 and Deg-100 in insulin-naive adults with T2D. In this subanalysis, endpoints were studied by predefined (</>= 65 years, N = 596/333) and post hoc (</>= 70 years, N = 768/161) age groups. Results Heterogeneity of treatment effect was observed for HbA1c reductions across the </>= 70 years subgroups, but not across the </>= 65 years subgroups, with greater HbA1c reductions with Gla-300 versus IDeg-100 in those 70 years or older (least squares mean -0.34% [95% confidence interval: -0.589% to -0.100%]). There was no significant heterogeneity of treatment effect for incidence and rates of confirmed (<= 3.9 mmol/L [<= 70 mg/dL]) hypoglycaemia across any age subgroups over 24 weeks, but numerically lower incidence and rates were consistently observed for Gla-300 versus IDeg-100 in the 65 years or older and 70 years or older age groups in the initial 12 weeks. Conclusions Gla-300 may be a suitable treatment option in the growing population of older people with T2D. Further investigation is required to determine Gla-300 glycaemic benefits in high-risk populations without increasing the risk of hypoglycaemia.