Comparison of Glycemic Variability and Hypoglycemic Events in Hospitalized Older Adults Treated with Basal Insulin plus Vildagliptin and Basal–Bolus Insulin Regimen: A Prospective Randomized Study

Abstract

Background: The basal–bolus insulin regimen is recommended in hospitalized patients with diabetes mellitus (DM), but has an increased risk of hypoglycemia. We aimed to compare dipeptidyl peptidase 4 inhibitors (DPP4-i) and basal–bolus insulin glycemic outcomes in hospitalized type 2 DM patients. Methods and patients: Our prospective randomized study included 102 elderly T2DM patients (82 ± 9 years, HbA1c 6.6% ± 1.9). Glycemic control: A variability coefficient assessed by continuous glucose monitoring (Free Style® sensor), mean insulin dose and hypoglycemia rates obtained with the two treatments were analyzed. Results: No differences were found between groups in glycemic control (mean daily glycemia during the first 10 days: 152.6 ± 38.5 vs. 154.2 ± 26.3 mg/dL; p = 0.8). The total doses Kg/day were 0.40 vs. 0.20, respectively (p < 0.001). A lower number of hypoglycemic events (9% vs. 15%; p < 0.04) and lower glycemic coefficient of variation (22% vs. 28%; p < 0.0002) were observed in the basal–DPP4-i compared to the basal–bolus regimen group. Conclusions: Treatment of inpatient hyperglycemia with basal insulin plus DPP4-i is an effective and safe regimen in old subjects with T2DM, with a similar mean daily glucose concentration, but lower glycemic variability and fewer hypoglycemic episodes compared to the basal bolus insulin regimen.

Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

“…For example, in a 6 month open-label RCT comparing a DPP-4i (linagliptin) with basal insulin (glargine) in long-term care and skilled nursing facilities, mean daily blood glucose was similar, with fewer hypoglycaemic events with linagliptin compared with insulin [ 181 ]. Treatment of inpatient hyperglycaemia with basal insulin plus DPP-4i has been demonstrated to be effective and safe in older adults with type 2 diabetes, with similar mean daily blood glucose but lower glycaemic variability and fewer hypoglycaemic episodes compared with the basal–bolus insulin regimen [ 182 ].…”

Treatment adherence and the contemporary approach to treating type 2 diabetes mellitus

“…Due to their high tolerability and modest efficacy, DPP4i may be suitable for specific populations. For instance, inpatient treatment of hyperglycaemia with basal insulin plus DPP4i has proven to be effective and safe in older adult patients with T2D, yielding similar glycaemic levels but with less glycaemic variability and fewer hypoglycaemic episodes compared with basal-bolus insulin regimens 37 .…”

Hypoglycemia in patients with type 2 diabetes mellitus during hospitalization: associated factors and prognostic value

“…However, these studies showed inconclusive results regarding the influence of glycemic control prior to admission on the appearance of hypoglycemia [ 6 , 7 ]. Few studies have addressed the influence of antidiabetic drugs that are unlikely to produce hypoglycemia [ 11 ].…”