The use of dipeptidyl peptidase-4 (DPP-4) inhibitors alone or in combination with basal insulin is a safe and an effective treatment option for hospitalized patients with type 2 diabetes, according to the results of a post hoc analysis published in Endocrine Practice.
Insulin is the recommended treatment regimen for hyperglycemia in hospitalized patients with type 2 diabetes and hospital use of oral antidiabetic agents has not been recommended because there are limited data from randomized controlled trials. Researchers completed a post hoc analysis of pooled data from 3 randomized clinical trials to determine the efficacy and safety of DPP-4 inhibitors alone or in combination with basal insulin compared with a basal-bolus insulin regimen in general medicine and surgery patients with type 2 diabetes.
The Sita-Pilot, Sita-Hospital, and Linagliptin-Surgery studies included patients with type 2 diabetes aged 18 to 80 years who were expected to stay in hospital for >24 hours and had blood glucose levels between 140 and 400 mg/dL prior to random treatment assignment. Sitagliptin once daily, alone or in combination with basal insulin, was used in the Sita-Pilot and the Sita-Hospital studies, whereas linagliptin alone was used in the Linagliptin-Surgery study.
In total, 144 patients received a DPP-4 inhibitor alone, 158 received a DPP-4 inhibitor plus basal insulin, and 283 received a basal-bolus regimen. The primary outcome was to determine differences in mean daily blood glucose concentrations between the groups. All groups received correctional doses of rapid-acting insulin for blood glucose levels >140 mg/dL.
The pooled data from the 3 prospective clinical trials showed that hospital treatment with DPP-4 inhibitors alone or in combination with basal insulin resulted in a similar improvement in mean daily blood glucose concentration compared with a basal-bolus regimen (171±39 mg/dL, 171±42 mg/dL, and 172±45 mg/dL, respectively; P =.94). The percentage of patients achieving blood glucose levels within the target range of 70 to 180 mg/dL also did not differ between the groups (63%±32%, 60%±31%, and 64%±28%, respectively; P =.42).
Patients treated with DPP-4 inhibitors alone had fewer hypoglycemic events compared with those treated with DPP-4 inhibitors plus basal insulin or basal-bolus insulin (2%, 9%, and 10%, respectively; P =.004).
Median length of stay was similar with the 3 treatment regimens and was 4.0 days (interquartile range, 3-6 days) with DPP-4 inhibitors alone, 4.0 days (interquartile range, 3-8 days) with a combination of DPP-4 inhibitors plus insulin, and 4.0 days (interquartile range, 3-7 days) with a basal-bolus regimen (P =.12).
The study had several limitations, including the open-label design of the 3 clinical trials and the exclusion of patients admitted to an intensive care unit, those with significant kidney or liver dysfunction or severe hyperglycemia, and those who received a high insulin dose.
“[T]his post-hoc analysis supports the use of [DPP-4 inhibitors], alone or in combination with basal insulin in hospitalized patients with [type 2 diabetes] who were treated at home with diet, any combination of oral antidiabetic drugs, or with low-dose insulin therapy,” concluded the researchers.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Lorenzo-González C, Atienza-Sánchez E, Reyes-Umpierrez D, et al. Safety and efficacy of DPP4-inhibitors for management of hospitalized general medicine and surgery patients with type 2 diabetes [published online April 27, 2020]. Endocr Pract. doi:10.4158/EP-2019-0481