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Identification of predictors of response to basal insulin and DPP4 inhibitors in patients with type 2 diabetes failing to other therapies

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Abstract

Aim

Basal insulin and DPP4 inhibitors are both possible options in patients with type 2 diabetes failing to oral drugs. The identification of clinical predictors of success with either one of the two approaches could be of help in personalizing therapy.

Methods

The retrospective study was performed on a consecutive series of patients with type 2 diabetes (n = 1,002) failing to at least one oral agent, who had been prescribed either basal insulin or DPP4 inhibitors in the previous 2 years, with a duration of follow-up of at least 6 months. Clinical predictors of success after 6 months from the beginning of second-line treatment were identified in the cohort.

Results

Among patients receiving a prescription of basal insulin, the proportion of therapeutic success at 6 months was 26.5 %. At multivariate analysis, a higher age and BMI, and a lower duration of diabetes were associated with success, as well as treatment with acarbose; conversely, a history of ischemic heart disease was associated with failure. Prescription of DPP4 inhibitors produced a therapeutic success in 24.8 % of cases. At multivariate analysis, success was associated with a lower baseline HbA1c and duration of diabetes, and a higher BMI and comorbidity; in addition, a lower success rate was found in women after adjusting for other confounders.

Conclusions

The present data support the view that insulin treatment is preferable in patients with severe hyperglycemia, failing to one or more drugs, whereas DPP4 inhibitors appear to be more useful in those with comorbid conditions.

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Acknowledgments

The study was supported by an unrestricted Grant from Sanofi.

Conflicts of interest

Matteo Monami has received speaking fees from Astra Zeneca, Bristol Myers Squibb, Merck, Novartis, Novo Nordisk, Sanofi, Boehringer Ingelheim, Eli-Lilly, and Takeda. Benedetta Ragghianti, Nreu Besmir, Stefania Zannoni, and Valentina Vitale have no conflicts of interest to declare. Edoardo Mannucci has received consultancy fees from Merck and Novartis, speaking fees from Astra Zeneca, Bristol Myers Squibb, Merck, Jansen, Novo Nordisk, Sanofi, Boehringer Ingelheim, Eli-Lilly, and Novartis, and research grants from Merck, Novartis, and Takeda.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and Animal Rights disclosure

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Author information

Authors and Affiliations

  1. Division of Geriatric Cardiology and Medicine, Azienda Ospedaliero-Universitaria Careggi, Via delle Oblate 4, 50141, Florence, Italy

    Matteo Monami, Stefania Zannoni & Besmir Nreu

  2. Diabetes Agency, Careggi Teaching Hospital, Florence, Italy

    Benedetta Ragghianti, Valentina Vitale & Edoardo Mannucci

Authors
  1. Matteo Monami
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  2. Benedetta Ragghianti
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  3. Stefania Zannoni
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  4. Valentina Vitale
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  5. Besmir Nreu
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  6. Edoardo Mannucci
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Corresponding author

Correspondence to Matteo Monami.

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Managed by Antonio Secchi.

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Monami, M., Ragghianti, B., Zannoni, S. et al. Identification of predictors of response to basal insulin and DPP4 inhibitors in patients with type 2 diabetes failing to other therapies. Acta Diabetol 53, 35–40 (2016). https://doi.org/10.1007/s00592-015-0732-1

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  • DOI: https://doi.org/10.1007/s00592-015-0732-1

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