Exp Clin Endocrinol Diabetes 2018; 126(05): 268-276
DOI: 10.1055/s-0043-113453
Article
© Georg Thieme Verlag KG Stuttgart · New York

Switching from Premixed Insulin To Basal Insulin Analogue For Type 2 Diabetes and Role of Dipeptidyl Peptidase-4 Inhibitors

Fernando Gómez-Peralta
Unit of Endocrinology and Nutrition, Hospital General de Segovia, Miguel Servet, S/N, Segovia, Spain
,
Cristina Abreu
Unit of Endocrinology and Nutrition, Hospital General de Segovia, Miguel Servet, S/N, Segovia, Spain
,
Gustavo Mora-Navarro
Department of General Medicine, Centro de Salud Los Alpes, Calle Suecia, Madrid, Spain
,
Pilar López-Morandeira
Department of General Medicine, Centro de Salud Aquitania, Calle Aquitania, Madrid, Spain
,
Esteban Pérez-Gutierrez
Department of General Medicine, Centro de Salud María Jesús Hereza, Calle Jesús Miguel Haddad Blanco, Leganés, Spain
,
Blanca Cordero-García
Department of General Medicine, Centro de Salud Santa María Benquerencia, Calle Río Alberche, S/N, 45007 Toledo, Spain
,
Miguel Brito-Sanfiel
Unit of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Calle Manuel de Falla, Majadahonda, Spain
› Author Affiliations
Further Information

Publication History

received 16 February 2017
revised 07 June 2017

accepted 12 June 2017

Publication Date:
13 July 2017 (eFirst)

Abstract

Introduction This study aimed to confirm the usefulness of basal insulin analogue plus oral antidiabetic drugs (OADs) for type 2 diabetes (T2D) patients inadequately controlled with premixed insulin with/without OADs and assess the role of dipeptidyl peptidase-4 (DPP-4) inhibitors within this regimen in clinical practice.

Methods Spanish retrospective observational study that included 186 T2D patients with glycosylated hemoglobin (HbA1c) >7% (53 mmol/mol) despite premixed insulin with/without OADs who had been switched to basal insulin analogue plus OADs. Study data describing the situation before the treatment switch and 6 months later was retrospectively retrieved from patients’ medical charts.

Results Switching to a basal insulin plus OADs decreased HbA1c (−1.0%, p<0.001), fasting (−38.1 mg/dl, p<0.001) and postprandial glycemia (−36.1 mg/dl, p<0.001), with reduced body weight (−1.1 kg, p<0.001) and hypoglycemic episodes (−17.5%, p<0.001). 68 (36.6%) patients received a basal insulin plus DPP-4 inhibitor±metformin and 74 (39.8%) plus metformin only. The DPP-4 inhibitor±metformin group showed a greater HbA1c reduction than the metformin group (1.3±1.4% vs. 0.9±1.0%, p=0.022), with no significant differences between groups in hypoglycemic episodes.

Conclusions Basal insulin analogue plus OADs may be a useful treatment for type 2 diabetes patients inadequately controlled with premixed insulin. Administering DPP-4 inhibitors within this regimen may contribute to improve patients’ glycemia, with a favorable weight-change profile and without increasing hypoglycemia risk.