Umpierrez Guillermo, Gill Jasvinder, Hood David, Li Xuan, Núñez Ana
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Sanofi, Bridgewater, New Jersey, USA.
Diabetes Obes Metab. 2025 Feb;27(2):795-805. doi: 10.1111/dom.16075. Epub 2024 Nov 27.
Most type 2 diabetes (T2D) studies have predominantly enrolled White people aged <65 years. This retrospective study evaluated outcomes for iGlarLixi (fixed-ratio combination [FRC] of insulin glargine 100 U/mL and lixisenatide) versus basal-bolus or premixed insulin in African American, Asian and Hispanic adults with T2D aged ≥65 years.
Medicare claims data were assessed from beneficiaries receiving basal insulin who newly initiated iGlarLixi, basal-bolus insulin, or premixed insulin between 7/1/2019 and 12/30/2021. Groups were propensity score matched at baseline and followed for up to 12 months. Endpoints (primary: treatment persistence; secondary: treatment adherence, hypoglycaemia event rates, healthcare resource utilisation) were assessed using multivariable regression.
Treatment persistence was higher for iGlarLixi versus basal-bolus or premixed insulin in the overall population (26.9%, 7.6%, 18.9%; adjusted p < 0.0001) and numerically higher in all ethnic subgroups. Treatment adherence was numerically higher for iGlarLixi versus basal-bolus or premixed insulin in the overall population (28.0%, 8.0%, 19.0%) and in all subgroups. Hypoglycaemia event rates were numerically lower for iGlarLixi versus basal-bolus insulin or premixed insulin in the overall population (2.5, 3.8, 7.5/100 person-years' follow-up) and in all subgroups except Asians receiving basal-bolus insulin. All-cause and diabetes-related hospitalisation and emergency department visit event rates were lower with iGlarLixi versus basal-bolus insulin or premixed insulin in the overall population, and in all subgroups except for hospitalisations in Hispanics.
FRC therapies such as iGlarLixi represent an appropriate treatment option when intensifying basal insulin therapy in ethnic minority older adults with T2D.
大多数2型糖尿病（T2D）研究主要纳入65岁以下的白人。这项回顾性研究评估了甘精胰岛素利司那肽（甘精胰岛素100 U/mL与利司那肽的固定比例复方制剂[FRC]）与基础-餐时胰岛素或预混胰岛素相比，在年龄≥65岁的非裔美国、亚洲和西班牙裔T2D成人中的治疗效果。
评估2019年7月1日至2021年12月30日期间新开始使用甘精胰岛素利司那肽、基础-餐时胰岛素或预混胰岛素的接受基础胰岛素治疗的医疗保险受益人的索赔数据。各治疗组在基线时进行倾向评分匹配，并随访长达12个月。使用多变量回归评估终点指标（主要指标：治疗持续性；次要指标：治疗依从性、低血糖事件发生率、医疗资源利用情况）。
在总体人群中，甘精胰岛素利司那肽的治疗持续性高于基础-餐时胰岛素或预混胰岛素（分别为26.9%、7.6%、18.9%；校正p<0.0001），在所有种族亚组中数值上也更高。在总体人群（分别为28.0%、8.0%、19.0%）和所有亚组中，甘精胰岛素利司那肽的治疗依从性在数值上高于基础-餐时胰岛素或预混胰岛素。在总体人群（分别为2.5、3.8、7.5/100人年随访）以及除接受基础-餐时胰岛素的亚洲人之外的所有亚组中，甘精胰岛素利司那肽的低血糖事件发生率在数值上低于基础-餐时胰岛素或预混胰岛素。在总体人群以及除西班牙裔住院情况之外的所有亚组中，甘精胰岛素利司那肽的全因和糖尿病相关住院及急诊科就诊事件发生率低于基础-餐时胰岛素或预混胰岛素。
在老年少数族裔T2D患者强化基础胰岛素治疗时，甘精胰岛素利司那肽等FRC疗法是一种合适的治疗选择。
