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Panminerva Medica 2021 Apr 21

DOI: 10.23736/S0031-0808.21.04085-4

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Management of older hospitalized patients with type 2 diabetes using linagliptin: Lina-Older Study

Luis M. PÉREZ-BELMONTE 1, 2, 3, 4 , Julio OSUNA-SÁNCHEZ 4, 5, Michele RICCI 1, Mercedes MILLÁN-GÓMEZ 3, María D. LÓPEZ-CARMONA 1, Miguel A. BARBANCHO 4, M. Rosa BERNAL-LÓPEZ 1, 6, Sergio JANSEN-CHAPARRO 1 , José P. LARA 4, Ricardo GÓMEZ-HUELGAS 1, 6

1 Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain; 2 Servicio de Medicina Interna, Hospital Hospital Helicópteros Sanitarios, Marbella, Spain; 3 Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; 4 Unidad de Neurofisiología Cognitiva, Centro de Investigaciones Médico Sanitarias (CIMES), Facultad de Medicina, Universidad de Málaga (UMA), Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; 5 Servicio de Medicina Interna, Hospital Comarcal de La Axarquía, Vélez-Málaga, Málaga, Spain; 6 Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain


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BACKGROUND: Older patients managed with intensive antidiabetic therapy are more likely to be harmed. Our study’s primary endpoint was to analyze the safety and efficacy of linagliptin in combination with basal insulin versus basal-bolus insulin in patients with 75 years of age or older hospitalized in medicine and surgery departments in real-world clinical practice.
METHODS: We retrospectively enrolled non-critically patients ≥75 years with type 2 diabetes admitted to medicine and non-cardiac surgery departments with admission glycated haemoglobin <8%, admission blood glucose <240mg/dL, and without at-home injectable therapies managed with our hospital’s antihyperglycemic protocol (basal-bolus or linagliptin-basal regimens) between January 2016 and December 2018. To match each patient who started on the basal-bolus regimen with a patient who started on the linagliptin-basal regimen, a propensity matching analysis was used.
RESULTS: Post-matching, 198 patients were included in each group. There were no significant differences in mean daily blood glucose levels after admission (p=0.203); patients with mean blood glucose 100-140mg/dL (p=0.134), 140-180mg/dL (p=0.109), or >200mg/dL (p=0.299); and number and day of treatment failure (p=0.159 and p=0.175, respectively). The total insulin dose and the number of daily injections were significantly lower in the linagliptin-basal group (both, p<0.001). Patients on the basal-bolus insulin regimen had more total hypoglycemic events than patients on the linagliptin-basal insulin regimen (p<0.001).
CONCLUSIONS: The linagliptin-basal insulin regimen was an effective alternative with fewer hypoglycemic events and daily insulin injections than intensive basal-bolus insulin in very old patients with type 2 diabetes with mild-to-moderate hyperglycemia treated at home without injectable therapies.


KEY WORDS: Diabetes mellitus; Older; Linagliptin; Hospitalization; Hyperglycemia

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