Investigation of Severe Hypoglycemia Risk Among Patients with Diabetes Treated with Ultra-Rapid Lispro in Japan

Abstract

Introduction: There is no information on the incidence of severe hypoglycemia in real-world patients with diabetes receiving ultra-rapid lispro (URLi). This post-marketing, observational, safety study assessed the incidence proportion and incidence rate of the first severe hypoglycemia event requiring a hospital visit in URLi-treated patients. It also compared the risk of severe hypoglycemia between patients treated with URLi or other rapid-acting insulin analogs (RAIAs).

Methods: Claims data were obtained from a nationwide hospital-based administrative database in Japan (Medical Data Vision). Adults with diabetes who initiated URLi or other RAIA on/after June 01, 2020, were followed up through May 31, 2023. Severe hypoglycemia was identified using a validated algorithm. Incidence proportion and incidence rate of the first severe hypoglycemia event requiring a hospital visit was described in URLi-treated patients (descriptive analysis). These outcomes were also compared against propensity score (PS)-matched other RAIA-treated patients (comparator; comparative analysis). Hazard ratio (HR) and 95% confidence interval (CI) was estimated with a Cox proportional hazards model.

Results: The descriptive analysis' URLi-treated cohort included 17,838 patients [mean (standard deviation, SD) age 65.9 (15.7) years; 58.3% male]. The majority had type 2 diabetes (75.7%). The incidence proportion of the first severe hypoglycemia event requiring a hospital visit was 0.6% (95% CI 0.5, 0.8) and the incidence rate was 1.7 per 100 person-years (95% CI 0.7, 4.3). The comparative analysis included 10,592 URLi-treated and 52,917 comparator-treated patients. The incidence rate of severe hypoglycemia did not significantly differ between these cohorts (HR 0.8; 95% CI 0.5, 1.1; p = 0.132;.

Conclusion: This study did not show a statistically significant increase in the incidence and risk of the first severe hypoglycemia event requiring a hospital visit in real-world URLi-treated patients in Japan, compared with a PS-matched cohort of other RAIA-treated patients.

Keywords: Claims data; Diabetes; Japan; Observational study; Post-marketing safety study; Propensity score matching; Real-world; Severe hypoglycemia; Ultra-rapid lispro.

Fig. 1

Study design. URLi ultra-rapid lispro

Fig. 2

Patient selection for the descriptive and comparative analyses: i Patient selection for the URLi-treated cohort (descriptive analysis), and ii and iii patient selection for the URLi-treated and comparator-treated cohorts, respectively (comparative analysis). MDV medical data vision.^a International Classification of Diseases, 10th revision codes E10, E11, E14, O24.0, O24.1, and O24.9^b Includes disease codes, prescription codes, procedure codes, or Diagnosis Procedure Combination data^c Excluding patients who were prescribed rapid-acting insulin analogs other than URLi prior to the first prescription of URLi during the patient selection period^d Excluding patients who were prescribed URLi prior to the first prescription of rapid-acting insulin analogs other than URLi during the patient selection period