scholarly journals Use of Linagliptin for the Management of Medicine Department Inpatients with Type 2 Diabetes in Real-World Clinical Practice (Lina-Real-World Study)

2018 ◽  
Vol 7 (9) ◽  
pp. 271 ◽  
Author(s):  
Luis Pérez-Belmonte ◽  
Juan Gómez-Doblas ◽  
Mercedes Millán-Gómez ◽  
María López-Carmona ◽  
Ricardo Guijarro-Merino ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Practice ◽  
Blood Glucose ◽  
Real World ◽  
Basal Insulin ◽  
Insulin Regimen ◽  
Medicine Department ◽  
Bolus Insulin ◽  
Basal Bolus

The use of noninsulin antihyperglycaemic drugs in the hospital setting has not yet been fully described. This observational study compared the efficacy and safety of the standard basal-bolus insulin regimen versus a dipeptidyl peptidase-4 inhibitor (linagliptin) plus basal insulin in medicine department inpatients in real-world clinical practice. We retrospectively enrolled non-critically ill patients with type 2 diabetes with mild to moderate hyperglycaemia and no injectable treatments at home who were treated with a hospital antihyperglycaemic regimen (basal-bolus insulin, or linagliptin-basal insulin) between January 2016 and December 2017. Propensity score was used to match patients in both treatment groups and a comparative analysis was conducted to test the significance of differences between groups. After matched-pair analysis, 227 patients were included per group. No differences were shown between basal-bolus versus linagliptin-basal regimens for the mean daily blood glucose concentration after admission (standardized difference = 0.011), number of blood glucose readings between 100–140 mg/dL (standardized difference = 0.017) and >200 mg/dL (standardized difference = 0.021), or treatment failures (standardized difference = 0.011). Patients on basal-bolus insulin received higher total insulin doses and a higher daily number of injections (standardized differences = 0.298 and 0.301, respectively). Basal and supplemental rapid-acting insulin doses were similar (standardized differences = 0.003 and 0.012, respectively). There were no differences in hospital stay length (standardized difference = 0.003), hypoglycaemic events (standardized difference = 0.018), or hospital complications (standardized difference = 0.010) between groups. This study shows that in real-world clinical practice, the linagliptin-basal insulin regimen was as effective and safe as the standard basal-bolus regimen in non-critical patients with type 2 diabetes with mild to moderate hyperglycaemia treated at home without injectable therapies.

SAFETY AND EFFICACY OF DPP-4 INHIBITORS FOR THE MANAGEMENT OF HOSPITALIZED GENERAL MEDICINE AND SURGERY PATIENTS WITH TYPE 2 DIABETES

2020 ◽  
Vol 26 (7) ◽  
pp. 722-728 ◽  
Author(s):  
Cristina Lorenzo-González ◽  
Elena Atienza-Sánchez ◽  
David Reyes-Umpierrez ◽  
Priyathama Vellanki ◽  
Georgia M. Davis ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Basal Insulin ◽  
General Medicine ◽  
Insulin Regimen ◽  
Oral Agents ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Bolus Insulin ◽  
Basal Bolus

Objective: DPP-4 inhibitors (DPP-4i) have been shown to be effective for the management of inpatient diabetes. We report pooled data from 3 prospective studies using DPP-4i in general medicine and surgery patients with type 2 diabetes (T2D). Methods: We combined data from 3 randomized studies comparing DPP-4i alone or in combination with basal insulin or a basal-bolus insulin regimen. Medicine (n = 266) and surgery (n = 319) patients admitted with a blood glucose (BG) between 140 and 400 mg/dL, treated with diet, oral agents, or low-dose insulin therapy were included. Patients received DPP-4i alone (n = 144), DPP-4i plus basal insulin (n = 158) or basal-bolus regimen (n = 283). All groups received correctional doses with rapid-acting insulin for BG >140 mg/dL. The primary endpoint was differences in mean daily BG between groups. Secondary endpoints included differences in hypoglycemia and hospital complications. Results: There were no differences in mean hospital daily BG among patients treated with DPP-4i alone (170 ± 37 mg/dL), DPP-4i plus basal (172 ± 42 mg/dL), or basalbolus (172 ± 43 mg/dL), P = .94; or in the percentage of BG readings within target of 70 to 180 mg/dL (63 ± 32%, 60 ± 31%, and 64 ± 28%, respectively; P = .42). There were no differences in length of stay or complications, but hypoglycemia was less common with DPP-4i alone (2%) compared to DPP-4i plus basal (9%) and basal-bolus (10%); P = .004. Conclusion: Treatment with DPP-4i alone or in combination with basal insulin is effective and results in a lower incidence of hypoglycemia compared to a basal-bolus insulin regimen in general medicine and surgery patients with T2D. Abbreviations: BG = blood glucose; BMI = body mass index; CI = confidence interval; DPP-4i = dipeptidyl peptidase-4 inhibitors; HbA1c = hemoglobin A1c; OR = odds ratio; T2D = type 2 diabetes

scholarly journals Hypoglycemia Incidence and Factors Associated in a Cohort of Patients With Type 2 Diabetes Hospitalized in General Ward Treated With Basal Bolus Insulin Regimen Assessed by Continuous Glucose Monitoring

2019 ◽  
Vol 14 (2) ◽  
pp. 233-239 ◽  
Author(s):  
Ana María Gómez ◽  
Angélica Imitola Madero ◽  
Diana Cristina Henao Carrillo ◽  
Martín Rondón ◽  
Oscar Mauricio Muñoz ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glucose Monitoring ◽  
Glycemic Variability ◽  
General Ward ◽  
Insulin Regimen ◽  
Factors Associated ◽  
Bolus Insulin ◽  
Mean Glucose ◽  
Basal Bolus

Introduction: Continuous glucose monitoring (CGM) is a better tool to detect hyper and hypoglycemia than capillary point of care in insulin-treated patients during hospitalization. We evaluated the incidence of hypoglycemia in patients with type 2 diabetes (T2D) treated with basal bolus insulin regimen using CGM and factors associated with hypoglycemia. Methods: Post hoc analysis of a prospective cohort study. Hypoglycemia was documented in terms of incidence rate and percentage of time <54 mg/dL (3.0 mmol/L) and <70 mg/dL (3.9 mmol/L). Factors evaluated included glycemic variability analyzed during the first 6 days of basal bolus therapy. Results: A total of 34 hospitalized patients with T2D in general ward were included, with admission A1c of 9.26 ± 2.62% (76.8 ± 13 mmol/mol) and mean blood glucose of 254 ± 153 mg/dL. There were two events of hypoglycemia below 54 mg/dL (3.0 mmol/L) and 11 events below 70 mg/dL (3.9 mmol/L) with an incidence of hypoglycemic events of 0.059 and 0.323 per patient, respectively. From second to fifth day of treatment the percentage of time in range (140-180 mg/dL, 7.8-10.0 mmol/L) increased from 72.1% to 89.4%. Factors related to hypoglycemic events <70 mg/dL (3.9 mmol/L) were admission mean glucose (IRR 0.86, 95% CI 0.79, 0.95, P < .01), glycemic variability measured as CV (IRR 3.12, 95% CI 1.33, 7.61, P < .01) and SD, and duration of stay. Conclusions: Basal bolus insulin regimen is effective and the overall incidence of hypoglycemia detected by CGM is low in hospitalized patients with T2D. Increased glycemic variability as well as the decrease in mean glucose were associated with events <70 mg/dL (3.9 mmol/L).

scholarly journals Efficacy And Safety of Empagliflozin Continuation in Patients With Type 2 Diabetes Hospitalised For Acute Decompensated Heart Failure

2021 ◽  
Author(s):  
Luis M Pérez-Belmonte ◽  
Michele Ricci ◽  
Jaime Sanz-Cánovas ◽  
Mercedes Millán-Gómez ◽  
Julio Osuna-Sánchez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Urine Output ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Insulin Regimen ◽  
Propensity Matching ◽  
Bolus Insulin ◽  
Basal Bolus

Abstract Background: Sodium−glucose cotransporter 2 inhibitors have been shown to reduce hospitalisations for acute decompensated heart failure in patients with and without type 2 diabetes. However, there is little evidence on their use in hospitalised patients. This work aims to analyse the glycaemic and clinical efficacy and safety of empagliflozin continuation in patients with type 2 diabetes hospitalised for acute decompensated heart failure.Methods: This real-world study included non-critically ill patients with diabetes hospitalised for acute decompensated heart failure and treated with empagliflozin for at least three months prior to the hospitalisation between 2017 and 2020. According to our in-hospital antihyperglycaemic protocol, patients could be treated with two possible regimens: a basal-bolus insulin regimen and an empagliflozin-basal insulin regimen. Our primary endpoints were difference in glycaemic control, as measured via mean daily blood glucose level, and differences in the visual analogue scale dyspnoea score, NT-proBNP levels, diuretic response, and cumulative urine output. Safety endpoints were also analysed. A propensity matching analysis was used to match a patient on one regimen with a patient on the other regimen. The probability of starting the regimes was estimated with a logistic regression model including variables that could have affected treatment assignment or outcomes as independent variablesResults: After a propensity matching analysis, 91 patients were included in each group. There were no differences in mean blood glucose levels (152.1 ± 17.8 vs 155.2 ± 19.7 mg/dl, p=0.289). At discharge, NT-proBNP levels were lower and cumulative urine output greater in the empagliflozin group versus the basal-bolus insulin group (1,652 ± 501 vs 2,101 ± 522 pg/mL, p=0.032 and 16,100 ± 1,510 vs 13,900 ± 1,220 ml, p=0.037, respectively). Patients who continued empagliflozin had a lower total number of hypoglycaemic episodes (36 vs 64, p<0.001). No differences were observed in adverse events, length of hospital stay, or in-hospital deaths.Conclusions: For patients with acute heart failure, an in-hospital antihyperglycaemic regimen that includes continuation of empagliflozin achieved effective glycaemic control, lower NT-proBNP, and greater urine output. It was also safer, as it reduced hypoglycaemic episodes without increasing other safety endpoints.

scholarly journals The relationships between glucose variability and renal function in type 2 diabetes patients on basal-bolus insulin therapy

2015 ◽  
Vol 18 (4) ◽  
pp. 66-71 ◽  
Author(s):  
Vadim V. Klimontov ◽  
Natalia E. Myakina
Keyword(s):  
Type 2 Diabetes ◽  
Renal Function ◽  
Blood Glucose ◽  
Insulin Therapy ◽  
Glucose Variability ◽  
High Blood Glucose ◽  
Interstitial Glucose ◽  
Bolus Insulin ◽  
Basal Bolus

Aim. To assess the relationship of glucose variability (GV) and renal function in patients with type 2 diabetes on basal-bolus insulin therapy.Materials and methods. We observed 101 females with type 2 diabetes, aged 47–79 years, with a glomerular filtration rate (GFR) 30 mL/min/1.73 m2. Insulin was combined with metformin in 45 of these women. The mean glucose and standard deviation, continuous overlapping net glucose action, lability index, J-index, low blood glucose index (LBGI), high blood glucose index (HBGI), M-value and mean absolute glucose (MAG) were calculated based on the results of blinded continuous glucose monitoring. The prevalence of episodes of low interstitial glucose (3.9 and 2.8 mmol/L) of at least 20-min duration was estimated.Results. Patients with a GFR of 30–44 mL/min/1.73 m2 had significantly lower HBGI, J-index, MAG and M-value compared with those with better filtration (all p 0.05); LBGI was not dependent on GFR. The GFR values were weakly and positively correlated with HBGI, J-index, M-value and MAG. Multiple regression analysis showed that GFR is an independent predictor of MAG (p = 0.04). No significant differences were found in the prevalence of episodes of low interstitial glucose between patients with different GFR ranges.Conclusions. GV parameters are related to renal function in type 2 diabetic women on basal-bolus insulin therapy. Patients with stage 3b chronic kidney disease have reduced GV, predominantly in the hyperglycaemic band, compared with those with better filtration.

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