Linagliptin preferable to insulin in majority of surgical type 2 diabetes patients
medwireNews: Daily linagliptin is effective and reduces hypoglycemia risk relative to multidose insulin in type 2 diabetes patients with mild-to-moderate hyperglycemia who are undergoing non-cardiac surgery, suggest the results of a randomized controlled study.
Overall, among the patients whose admission blood glucose levels were between 7.8 and 22.2 mmol/L, mean daily blood glucose levels were significantly higher in the 128 patients receiving the dipeptidyl peptidase-4 inhibitor linagliptin 5 mg/day versus the 122 given basal–bolus insulin, at 9.5 versus 8.8 mmol/L.
However, when only participants with a randomization blood glucose level below 11.1 mmol/l were included – accounting for 63% of the cohort – the level of blood glucose control was similar between the two treatment groups, at 8.9 mmol/L in the linagliptin group and 8.7 mmol/L in the basal–bolus group.
Moreover, the linagliptin group had an 86% reduced risk for hypoglycemia (blood glucose <3.9 mmol/L), with a rate of 1.6% in the linagliptin group versus 11.0% in the basal–bolus group.
“One episode of hypoglycaemia was prevented for every 11 patients treated with linagliptin compared to basal-bolus insulin,” Guillermo Umpierrez (Emory University School of Medicine, Atlanta, Georgia, USA) and co-researchers comment in Diabetes, Obesity & Metabolism.
They therefore believe that “this simplified regimen with a single oral agent is efficacious in patients with mild to moderate hyperglycaemia.”
There was also no difference between the two groups in duration of hospital stay and rate of perioperative complications.“Since linagliptin does not need dose titration, it offers an easier alternative than the basal-bolus insulin regimen for glycaemic control in most non-cardiac surgical patients with [type 2 diabetes],” say the researchers.
But they believe that insulin “should be the preferred treatment of choice” for patients with blood glucose levels above 11.1 mmol/L, who are more likely to have advanced, poorly controlled diabetes.
“Due to the duration of diabetes, these patients likely needed to be on insulin therapy as outpatient and therefore need to be on insulin therapy as inpatient,” they say.
By Catherine Booth
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