1. Glycaemic efficacy and safety of linagliptin for the management of non-cardiac surgery patients with type 2 diabetes in a real-world setting: Lina-Surg study.
- Author
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Pérez-Belmonte LM, Osuna-Sánchez J, Millán-Gómez M, López-Carmona MD, Gómez-Doblas JJ, Cobos-Palacios L, Sanz-Cánovas J, Barbancho MA, Lara JP, Jiménez-Navarro M, Bernal-López MR, and Gómez-Huelgas R
- Subjects
- Aged, Diabetes Mellitus, Type 2 blood, Diabetes Mellitus, Type 2 surgery, Dipeptidyl-Peptidase IV Inhibitors adverse effects, Drug Therapy, Combination, Female, Glycated Hemoglobin analysis, Hospitalization, Humans, Hypoglycemia chemically induced, Hypoglycemia epidemiology, Hypoglycemic Agents administration & dosage, Hypoglycemic Agents therapeutic use, Insulin administration & dosage, Insulin therapeutic use, Linagliptin adverse effects, Male, Middle Aged, Safety, Spain epidemiology, Treatment Failure, Treatment Outcome, Blood Glucose drug effects, Diabetes Mellitus, Type 2 drug therapy, Dipeptidyl-Peptidase IV Inhibitors therapeutic use, Linagliptin therapeutic use
- Abstract
Introduction: The use of dipeptidyl peptidase-4 inhibitors in hospitalized patients is an area of active research. We aimed to compare the efficacy and the safety of the basal-bolus insulin regimen versus linagliptin-basal insulin in non-critically ill non-cardiac surgery patients in a real-world setting. Methods: We enrolled patients with type 2 diabetes hospitalized in non-cardiac surgery departments with admission glycated haemoglobin level < 8%, admission blood glucose concentration < 240 mg/dL, and no at-home injectable treatments who were treated with basal-bolus ( n = 347) or linagliptin-basal ( n = 190) regimens between January 2016 and December 2017. To match patients on the two regimens, a propensity matching analysis was performed. Results: After matching, 120 patients were included in each group. No differences were noted in mean blood glucose concentration after admission ( p = .162), number of patients with a mean blood glucose 100-140 mg/dL ( p = .163) and > 200 mg/dL ( p = .199), and treatment failures ( p = .395). Total daily insulin and number of daily insulin injections were lower in the linagliptin-basal group (both p < .001). Patients on linagliptin-basal insulin had fewer hypoglycaemic events (blood glucose < 70 mg/dL) ( p < .001). Conclusion: For type 2 diabetes surgery patients with mild to moderate hyperglycaemia without pre-hospitalization injectable therapies, linagliptin-basal insulin was an effective, safe alternative with fewer hypoglycaemic events in real-world practice. Key messages Treatment with basal-bolus insulin regimens is the standard of care for non-critically ill hospitalized patients with type 2 diabetes. A differentiated treatment protocol that takes into account glycaemic control and clinical factors should be implemented in the hospital setting. Linagliptin-basal insulin is an effective, safe alternative with fewer hypoglycaemic events during the hospitalization of non-critically ill non-cardiac surgery patients with T2D in real-world practice.
- Published
- 2019
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