Inpatient blood sugar control is usually poor and insulin therapy is not always prescribed. Reluctance to initiate insulin is due to the labor intensity of the treatment, which involves several insulin injections daily, frequent blood sugar monitoring, and fear of hypoglycemia. However, a study published in the Endocrine Practice on July 2020 suggests that Dipeptidyl peptidase-4 inhibitor (DPP-4i) treatment alone or combined with basal insulin is effective and results in lower hypoglycemia incidence compared with basal-bolus insulin regimens in general medicine and surgery in patients with type 2 diabetes.
Hospital use of oral antidiabetic agents (OADs) has not been recommended in clinical guidelines due to limited safety and efficacy data from randomized controlled trials. However, 4 recent randomized controlled trials on Sitagliptin, linagliptin and saxagliptin have reported on the safety and efficacy of dipeptidyl peptidase-4 inhibitors (DPP-4i) in general medicine and surgical patients with T2D. Dr Cristina Lorenzo-González and colleagues conducted a posthoc analysis of pooled data from the above 3 randomized multi-center clinical trials ( NCT01378117, NCT01845831, NCT02004366), to assess the efficacy and safety of treatment with DPP-4i or the combination of DPP-4i plus basal insulin compared to basal-bolus insulin regimen (standard of care) in general medicine and surgery patients with T2D.
Researchers combined the data from 3 randomized studies comparing DPP-4i alone or in combination with basal insulin or a basal-bolus insulin regimen. They included, Medicine (n = 266) and surgery (n = 319) patients admitted with blood glucose (BG) between 140 and 400 mg/dL, treated with diet, oral agents, or low-dose insulin therapy. They analyzed the patients who received DPP-4i alone (n = 144), DPP-4i plus basal insulin (n = 158) or basal-bolus regimen (n = 283). The major outcome assessed was the differences in mean daily BG between groups. They also assessed differences in hypoglycemia and hospital complications.
Key findings of the study were:
• Upon multivariate model adjusted for HbA1c, age, sex, and BMI, researchers found no difference in the percentage of BG readings within the target of 70 to 180 mg/dL (63 ± 32%, 60 ± 31%, and 64 ± 28% respectively).
• They also found no differences in mean hospital daily BG among patients treated with DPP-4i alone (170 ± 37 mg/dL), DPP-4i plus basal (172 ± 42 mg/dL), or basal-bolus (172 ± 43 mg/dL).
• They also noted no differences in length of stay or complications.
• However, they found that the hypoglycemia was less common with DPP-4i alone (2%) compared to DPP-4i plus basal (9%) and basal-bolus (10%).
The authors concluded, "Treatment with DPP-4i alone or in combination with basal insulin is effective and results in a lower incidence of hypoglycemia compared to a basal-bolus insulin regimen in general medicine and surgery patients with T2D".
For further information:
https://www.endocrinepractice.org/article/S1530-891X(20)36014-6/fulltext#%20