Basal insulin combined with DPP-4i PK basal insulin combined with prandial insulin-the latest real-world study explores the optimal treatment options for T2DM in the elderly or with ADHF

*Only for medical professionals to read for reference.
A quick overview of the content of this article: Basic-meal insulin is a commonly used hypoglycemic treatment for hospitalized patients, but there are disadvantages such as complex clinical operations and high risk of hypoglycemia, which limit the clinical use of special patients.

For non-severe type 2 diabetes mellitus (T2DM) ≥75 years of age or acute decompensated heart failure (ADHF), the latest real-world data suggest that compared to basic-meal insulin therapy, linagliptin combined The hypoglycemic effect of basic insulin therapy is similar, and the incidence of hypoglycemia is lower, and the amount of insulin and the number of injections are less.

Insulin is a commonly used hypoglycemic agent for T2DM inpatients.
The guidelines recommend multiple insulin treatments (basal insulin combined with mealtime insulin) for hypoglycemic treatment of non-severe T2DM inpatients[1], which can improve patient blood sugar control and reduce hospitalization complications The risk of disease [2].

However, basic-meal insulin therapy requires frequent injections and blood glucose monitoring.
In addition, basic-meal insulin therapy has a higher risk of hypoglycemia [3], especially in elderly patients or special hospitalized patients with acute diseases.
The hypoglycemic therapy is impaired (such as drug-induced hypoglycemia, etc.
) [1-2,4], which makes clinical treatment more difficult and restricts the choice of treatment options.

Therefore, a safer and simpler hypoglycemic regimen is needed for the clinical treatment of hospitalized patients.

Due to adverse reactions or contraindications, the use of traditional oral hypoglycemic drugs in hospitalized patients has its own limitations.
For example, metformin can easily lead to an increased risk of lactic acidosis; sulfonylureas have the risk of hypoglycemia and weight gain; thiazolidinedione Such drugs may cause water and sodium retention and increase the risk of heart failure.However, in recent years, many studies have shown that dipeptidyl peptidase-4 inhibitors (DPP-4i) have good safety and effectiveness in the treatment of T2DM, such as not increasing hypoglycemia and body weight, and good gastrointestinal tolerance; and Studies have shown that the effectiveness of DPP-4i combined with basal insulin therapy and basal insulin combined with mealtime insulin regimens is consistent, which is helpful for the management of hyperglycemia in hospitalized patients with T2DM [4-7].

Different from other DPP-4i, because of its special metabolism and excretion mechanism, linagliptin is not affected by the reduction of liver and kidney function.
It is used in patients with different liver and kidney functions without adjusting the dose; at the same time, because of linagliptin Ting hypoglycemic is glucose-dependent, and clinical use does not increase the risk of hypoglycemia.
It is one of the ideal hypoglycemic drugs for hospitalized patients with T2DM [4,6-8].

Recently, two new real-world studies have been released for two types of special T2DM hospitalized patients: elderly patients ≥75 years old and hospitalized patients with ADHF, evaluating the effectiveness of ligaglipe combined with basal insulin therapy compared with basal insulin combined with mealtime insulin And safety, research data provides new evidence support for clinical hypoglycemic options.

Linagliptin-basal insulin is an effective, safe and convenient hypoglycemic choice for elderly T2DM hospitalized patients.
An observational, multi-center, real-world study [9], included in receiving basal insulin combined with mealtime insulin therapy or receiving Liger Inpatients with mild to moderate T2DM treated with gliptin combined with basal insulin.

After propensity matching (PM) analysis, there were 198 patients in each group.

The baseline characteristics between the two groups were consistent.

The study showed that there was no significant difference in the average daily blood glucose level between the two groups (P=0.
203) (Figure 1 ); the average blood glucose level was 100-140mg/dL (P=0.
134 ), 140-180mg/dL (P=0.
109) and> There was no significant difference in the proportion of patients with 200mg/dL (P=0.
299), the number of treatment failures and the number of days (P=0.
159 and P=0.
175). In addition, after PM analysis, compared with the basal-prandial insulin group, the total daily insulin dose of the linagliptin-basal insulin group (25.
2±5.
5 vs.
32.
0±5.
3 units, P<0.
001) and daily injection The frequency (2.
3±0.
6 vs.
4.
0±0.
0, P <0.
001) was significantly reduced.

There was no significant difference in the total dose of basal insulin and the total dose of supplemented short-acting insulin (P=0.
519, P=0.
492, respectively).

The value is the mean ± standard deviation.
Figure 1.
The average blood glucose level of the linagliptin-basal insulin group and the basal-meal insulin group.
In terms of safety, compared with the linagliptin-basal insulin group, the basal-meal insulin group The total number of hypoglycemia events in the group was higher (42 vs.
20, P<0.
001); the proportion of patients with 1 or ≥2 hypoglycemia events was significantly more; the incidence of hypoglycemia was higher; there were grade 1, grade 2, and grade 3 There are more patients with grade hypoglycemia.

The hospital stay of the two groups was similar, ranging from 4-12 days (96.
4% of the patients were hospitalized for 4-9 days), and the complication rate was similar in the two groups (P=0.
147).

This study is the first real-world study to evaluate the safety and effectiveness of DPP-4i in hospitalized patients ≥75 years of age with mild to moderate T2DM.

Elderly patients with T2DM often suffer from long-term illness, impaired liver and kidney function, complicated diseases, multiple combination medications, and poor compliance.
Such patients should pay attention to "de-enhancement" and simplify when receiving insulin therapy.
Insulin treatment program [10].

The results of the study show that the hypoglycemic effect of linagliptin-basal insulin therapy is consistent with that of basal-meal insulin, and the risk of linagliptin combined with basal insulin in the treatment of hypoglycemia is low, and the total daily insulin dose and the number of insulin injections are lower.
.

Linagliptin is a safer and simpler combination of basic insulin therapy for elderly T2DM hospitalized patients.

Linagliptin also showed good efficacy, safety and simplicity for hospitalized patients with acute decompensated heart failure and T2DM.
This multicenter, real-world study included 1821 patients with mild to moderate T2DM admitted to the hospital for ADHF According to the treatment status, they were divided into receiving linagliptin combined with basal insulin therapy and basal insulin combined with prandial insulin therapy.
After PM analysis, there were 146 patients in each group in each group [11].

The study showed that regardless of the blood glucose control status, the average blood glucose level of the two groups was not significantly different (163.
6±21.
2 vs.
159.
6±19.
2 mg/dL, P=0.
21).

Compared with the basal-meal insulin group, the linagliptin-basal insulin group had lower overall hypoglycemia occurrences (36 vs.
64, P<0.
001), and the proportion of patients who had 1 or ≥2 episodes of hypoglycemia The incidence of hypoglycemia and the proportion of any patients with blood glucose <70 and <54 mg/dL were low (Table 1).

In addition, the total insulin dose (24.
1±5.
3 vs.
32.
0±5.
6 units, P<0.
001) and the number of daily injections (2.
4±0.
8 vs.
4.
0±0.
0, P<0.
001) in the linagliptin-basal insulin treatment group were both significant Below base-mealtime insulin therapy [11].

Table 1.
After using PM analysis, the occurrence of hypoglycemia in the linagliptin-basal insulin group and the basal-meal insulin group PM: Propensity matching This real-world study is the first to focus on patients with ADHF and T2DM due to T2DM and heart strength The relationship between exhaustion, such patients are often accompanied by complicated conditions such as high risk of hospitalization, poor cardiovascular outcomes, and more combined medications.

In such patients, the research results also suggest the safety and convenience of linagliptin combined with basal insulin therapy.

In addition, linagliptin's cardiovascular outcome study CARMELINA study suggests that linagliptin does not increase the risk of major cardiovascular adverse events in patients with T2DM and the risk of heart failure-related events [12], which further suggests that linagliptin is effective for patients with ADHF and T2DM , Is a safe choice for lowering blood sugar.

To summarize the above two real-world studies, it is shown that for elderly T2DM hospitalized patients with complicated clinical treatments and T2DM hospitalized patients with ADHF, linagliptin combined with basal insulin therapy and basic-meal insulin therapy have similar anti-diabetic effects, and the combination Linagliptin has a lower incidence of hypoglycemia in the treatment of hypoglycemia, with fewer insulin dosages and fewer injections.

Linagliptin is the "preferred partner" for combination therapy with basal insulin.

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