Introduction: Insulin therapy is preferred as safest for glycaemic control in patients with elevated serum urea/creatinine level. Management of diabetes in grade 3-5 Chronic Kidney Disease (CKD) with oral hypoglycaemic is very challenging because most of them cause renal impairment and thus dose adjustment is needed in renal disease. Linagliptin, a DPP-4 (dipeptidyl peptidase-4) inhibitor has only 5% renal excretion; hence its dose adjustment is not needed in patients with CKD. Aim: To compare the efficacy and safety of linagliptin with insulin in patients of Type 2 Diabetes Mellitus (T2DM) with CKD. Materials and Methods: The present study was a longitudinal study, in which a total of 101 patients of grade 3-5 CKD with T2DM were divided into two groups, insulin group (n=54) and linagliptin group (n=47), based on their drug therapy. All the cases were tested for HbA1c (Glycated Haemoglobin), Random Blood Sugar (RBS), Creatinine clearance, Urine Protein-Creatinine Ratio (UPCR) and different adverse drug events at their first visit (baseline) and then during follow-up at 1st, 3rd, 6th and 12th month. Statistical analysis was done through GraphPad Instat by unpaired t-test for group comparison and Analysis of Variance (ANOVA) for intragroup comparison. Results: At the end of study, mean difference of RBS, Creatinine clearance and UPCR in both the groups were not significant. But mean HbA1c level was less in linagliptin group (6.62±0.10) as compared to insulin group (6.82±0.23) on long term therapy and the difference was statistically significant. Hypoglycaemia (33 vs 24), urinary tract infection (6 vs 5) and respiratory tract infection (5 vs 4) were more frequent in insulin group versus linagliptin group. Conclusion: Linagliptin for glycaemic control provides clinically meaningful improvements in long term glycaemic control without unacceptable side effects in CKD like vulnerable group of patients.
The influence of family characteristics on glycaemic control among adult patients with type 2 diabetes mellitus attending the general outpatient clinic, National Hospital, Abuja, Nigeria