Contributions of basal and prandial hyperglycemia to total hyperglycemia in older and younger adults with type 2 diabetes mellitus

J Am Geriatr Soc. 2013 Apr;61(4):535-41. doi: 10.1111/jgs.12167. Epub 2013 Mar 21.

Abstract

Objectives: To evaluate the relative contributions of basal and prandial components to total hyperglycemia in older and younger adults with type 2 diabetes mellitus.

Design: Participant-level data were pooled from six randomized studies of 24 weeks or longer treatment with insulin glargine or an active comparator.

Setting: Prospective, randomized Phase 3 or 4 controlled trials.

Participants: One thousand six hundred ninety-nine individuals: 509 (30%) aged 65 and older and 1,190 (70%) younger than 65.

Measurements: Contributions of basal hyperglycemia (BHG) and postprandial hyperglycemia (PPHG) to total hyperglycemia, defined as the incremental area under the curve of daytime blood glucose (BG) from the overall glucose profile calculated from 7-point self-measured BG profiles, of participants aged 65 and older were compared with those of participants younger than 65.

Results: After 24 weeks of treatment, glycosylated hemoglobin (HbA1c) decreased in the older (8.6-7.0%) and younger (8.7-7.1%) groups; the relative contribution of BHG was significantly lower in both age groups (P < .001). The relative contribution of BHG to that of PPHG was significantly smaller in older than in younger participants at baseline (75.4% vs 79.4%; P < .001) and 24 weeks (37.6% vs 44.7%; P < .001). The relative contribution of BHG to total hyperglycemia was not correlated with HbA1c at baseline and after 24 weeks of treatment in older participants but was positively correlated at baseline (correlation coefficient (r) = 0.082; P = .005) and 24 weeks (r = 0.062; P = .03) in younger participants. A significantly lower proportion of older participants reported symptomatic, glucose-confirmed, and nocturnal hypoglycemia during 24 weeks of treatment (P < .001).

Conclusion: The relative contribution of BHG was lower, and that of PPHG was greater in older than in younger participants, suggesting that different therapeutic approaches may be required to treat hyperglycemia effectively in these different age groups.

Publication types

  • Clinical Trial, Phase III
  • Clinical Trial, Phase IV
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Distribution
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Blood Glucose / drug effects
  • Blood Glucose / metabolism*
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / prevention & control
  • Dose-Response Relationship, Drug
  • Female
  • Glycated Hemoglobin A / metabolism*
  • Humans
  • Hyperglycemia / drug therapy*
  • Hyperglycemia / prevention & control
  • Hypoglycemic Agents / administration & dosage*
  • Insulin, Long-Acting / administration & dosage
  • Male
  • Middle Aged
  • Prospective Studies
  • Treatment Outcome

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin, Long-Acting