Comparison of Glycemic Variability and Hypoglycemic Events in Hospitalized Older Adults Treated with Basal Insulin plus Vildagliptin and Basal-Bolus Insulin Regimen: A Prospective Randomized Study

• Type of Material: Article
• Authors: Sol Batule, Hosp Badalona Germans Trias & Pujol; Analía Ramos, Hosp Badalona Germans Trias & Pujol; Alejandra Pérez-Montes De Oca, Hosp Badalona Germans Trias & Pujol; Natalia Fuentes, Hosp Badalona Germans Trias & Pujol; Santiago Martinez, Hosp Badalona Germans Trias & Pujol; Joan Raga, Hosp Badalona Germans Trias & Pujol; Xoel Pena, Hosp Badalona Germans Trias & Pujol; Cristina Tural, Hosp Badalona Germans Trias & Pujol; Pilar Munoz, Hosp Badalona Germans Trias & Pujol; Berta Soldevila, Hosp Badalona Germans Trias & Pujol; Nuria Alonso, Hosp Badalona Germans Trias & Pujol; Guillermo Umpierrez, Emory University; Manel Puig-Domingo, Hosp Badalona Germans Trias & Pujol
• Language: English
• Date: 2022-05-01
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/jcm11102813
• Title of Journal or Parent Work: Journal of Clinical Medicine
• Volume: 11
• Issue: 10
• Grant/Funding Information: This research received no external funding.
• Keywords: vildagliptin; diabetes mellitus; Medicine, General & Internal; Mortality; Management; Science & Technology; inpatient hyperglycaemia; Sitagliptin; Life Sciences & Biomedicine; older adults; Hyperglycemia; General & Internal Medicine
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Nutrition; Health Sciences, Health Care Management; Health Sciences, Public Health

Abstract

Background: The basal–bolus insulin regimen is recommended in hospitalized patients with diabetes mellitus (DM), but has an increased risk of hypoglycemia. We aimed to compare di-peptidyl peptidase 4 inhibitors (DPP4‐i) and basal–bolus insulin glycemic outcomes in hospitalized type 2 DM patients. Methods and patients: Our prospective randomized study included 102 elderly T2DM patients (82 ± 9 years, HbA1c 6.6% ± 1.9). Glycemic control: A variability coefficient assessed by continuous glucose monitoring (Free Style® sensor), mean insulin dose and hypoglycemia rates obtained with the two treatments were analyzed. Results: No differences were found between groups in glycemic control (mean daily glycemia during the first 10 days: 152.6 ± 38.5 vs. 154.2 ± 26.3 mg/dL; p = 0.8). The total doses Kg/day were 0.40 vs. 0.20, respectively (p < 0.001). A lower number of hypoglycemic events (9% vs. 15%; p < 0.04) and lower glycemic coefficient of variation (22% vs. 28%; p < 0.0002) were observed in the basal–DPP4‐i compared to the basal–bolus regimen group. Conclusions: Treatment of inpatient hyperglycemia with basal insulin plus DPP4‐i is an ef-fective and safe regimen in old subjects with T2DM, with a similar mean daily glucose concentra-tion, but lower glycemic variability and fewer hypoglycemic episodes compared to the basal bolus insulin regimen.