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

Authors

  • Fernando Gómez-Peralta

    1   Unit of Endocrinology and Nutrition, Hospital General de Segovia, Miguel Servet, S/N, Segovia, Spain
  • Cristina Abreu

    1   Unit of Endocrinology and Nutrition, Hospital General de Segovia, Miguel Servet, S/N, Segovia, Spain
  • Gustavo Mora-Navarro

    2   Department of General Medicine, Centro de Salud Los Alpes, Calle Suecia, Madrid, Spain
  • Pilar López-Morandeira

    3   Department of General Medicine, Centro de Salud Aquitania, Calle Aquitania, Madrid, Spain
  • Esteban Pérez-Gutierrez

    4   Department of General Medicine, Centro de Salud María Jesús Hereza, Calle Jesús Miguel Haddad Blanco, Leganés, Spain
  • Blanca Cordero-García

    5   Department of General Medicine, Centro de Salud Santa María Benquerencia, Calle Río Alberche, S/N, 45007 Toledo, Spain
  • Miguel Brito-Sanfiel

    6   Unit of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Calle Manuel de Falla, Majadahonda, Spain
Weitere Informationen

Publikationsverlauf

received 16. Februar 2017
revised 07. Juni 2017

accepted 12. Juni 2017

Publikationsdatum:
13. Juli 2017 (online)

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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.