Abstract
The use of noninsulin antihyperglycaemic drugs in the hospital setting has not yet been fully described. This observational study compared the efficacy and safety of the standard basal-bolus insulin regimen versus a dipeptidyl peptidase-4 inhibitor (linagliptin) plus basal insulin in medicine department inpatients in real-world clinical practice. We retrospectively enrolled non-critically ill patients with type 2 diabetes with mild to moderate hyperglycaemia and no injectable treatments at home who were treated with a hospital antihyperglycaemic regimen (basal-bolus insulin, or linagliptin-basal insulin) between January 2016 and December 2017. Propensity score was used to match patients in both treatment groups and a comparative analysis was conducted to test the significance of differences between groups. After matched-pair analysis, 227 patients were included per group. No differences were shown between basal-bolus versus linagliptin-basal regimens for the mean daily blood glucose concentration after admission (standardized difference = 0.011), number of blood glucose readings between 100–140 mg/dL (standardized difference = 0.017) and >200 mg/dL (standardized difference = 0.021), or treatment failures (standardized difference = 0.011). Patients on basal-bolus insulin received higher total insulin doses and a higher daily number of injections (standardized differences = 0.298 and 0.301, respectively). Basal and supplemental rapid-acting insulin doses were similar (standardized differences = 0.003 and 0.012, respectively). There were no differences in hospital stay length (standardized difference = 0.003), hypoglycaemic events (standardized difference = 0.018), or hospital complications (standardized difference = 0.010) between groups. This study shows that in real-world clinical practice, the linagliptin-basal insulin regimen was as effective and safe as the standard basal-bolus regimen in non-critical patients with type 2 diabetes with mild to moderate hyperglycaemia treated at home without injectable therapies.
Highlights
Patients with type 2 diabetes (T2D) are frequently admitted to the hospital in both medicine and surgery departments [1,2,3], with admission rates that are between 2 to 6 times higher than those of patient without diabetes [4,5]
Values are shown as mean ± standard deviations, absolute data and percentages. This observational, multicentre, real-world study found that the linagliptin-basal insulin regimen was as effective and safe as the basal-bolus insulin regimen in non-critically ill medicine department inpatients with T2D who have mild to moderate hyperglycaemia and who are treated at home without injectable therapies
The glycaemic control and hospital complications in patients with T2D treated with linagliptin-basal insulin were similar to what was observed with basal-bolus insulin regimen
Summary
Patients with type 2 diabetes (T2D) are frequently admitted to the hospital in both medicine and surgery departments [1,2,3], with admission rates that are between 2 to 6 times higher than those of patient without diabetes [4,5]. The use of subcutaneous basal-bolus regimen, which involves the administration of a daily basal insulin dose and rapid-acting insulin before meals, has resulted in improved glycaemic control and reduced risk of complications in the hospital setting [9,10]. This regimen, established as part of routine clinical practice, is limited because of its timeand labour-intensive implementation and the patient discomfort associated with requiring several subcutaneous insulin injections and blood glucose (BG) testing. Basal-bolus therapy has been linked to a higher risk of clinically important hypoglycaemia, which was reported in 12 to 32% of hospitalized patients with T2D [11,12]
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