Better Control With DPP-4 Inhibitors vs NPH Insulin in Type 2 Diabetes

NPH insulin
NPH insulin
Patients initiating DPP-4 inhibitors as third-line therapy in type 2 diabetes appeared to have lower discontinuation rates and less hypoglycemia compared with patients starting NPH insulin.

Patients with type 2 diabetes who use neutral protamine Hagedorn (NPH) insulin as a third-line therapy have poorer disease control compared with those using dipeptidyl peptidase-4 (DPP-4) inhibitors, according to new findings published in the Journal of Diabetes Research.

Currently, it is unclear which medications should be added to the regimen of patients with type 2 diabetes when metformin is insufficient.

In this retrospective cohort-designed study, the authors evaluated 54,318 individuals with type 2 diabetes who had NPH insulin or a DPP-4 inhibitor added to their treatment regimen as third-line therapy. Of this group, 50,338 (92.7%) filled prescriptions for DPP-4 inhibitor medications and 3980 (7.3%) filled prescriptions for NPH insulin.

NPH use was associated with a higher risk for discontinuation vs DPP-4 inhibitors (adjusted hazard ratio [HR] 1.33; 95% CI, 1.27-1.40) as well as a higher risk for hypoglycemia (adjusted HR 2.98; 95% CI, 2.72-3.28). The risk for cardiovascular events was similar across both groups (adjusted HR 1.08; 95% CI, 0.84-1.39).

A total of 1083 patients experienced at least one cardiovascular event: 2.31/100 person-years (95% CI, 2.17-2.46) for the NPH arm compared with 2.44/100 person-years (95% CI, 1.92-3.08) for the DPP-4 inhibitor group.

“These findings support previous evidence suggesting that DPP-4 inhibitor agents are well tolerated in [people with] type 2 diabetes [whose diabetes has not been controlled] with metformin plus sulfonylurea,” concluded the authors.

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Moura CS, Rosenberg ZB, Abrahamowicz M, Bernatsky S, Behlouli H, Pilote L. Treatment discontinuation and clinical events in type 2 diabetes patients treated with dipeptidyl peptidase-4 inhibitors or NPH insulin as third-line therapy. J Diabetes Res. 2018;2018:4817178.