Evaluation of Dipeptidyl Peptidase-IV Inhibitor Use in the Inpatient Setting

Abstract

Background: The American Diabetes Association recommends discontinuing non-insulin antihyperglycemic therapy during hospitalization and utilizing a basal insulin-containing regimen for patients with type 2 diabetes mellitus (T2DM). Limited research is available on the role of dipeptidyl peptidase-IV (DPP-IV) inhibitors in an inpatient real-world patient population. Objective: To determine the efficacy of DPP-IV inhibitor therapy in hospitalized patients with T2DM. Methods: Adult patients with T2DM and received at least one dose of DPP-IV inhibitor during hospitalization were included. The primary outcome was to determine the mean daily blood glucose (BG) readings in the overall patient population. Secondary outcomes included comparing study groups and evaluating mean daily blood glucose, hospital length of stay (LOS) and incidence of hypoglycemia. Results: One hundred and ninety-two patients were identified: 39 patients (20.3%) received DPP-IV inhibitor monotherapy, 104 (54.2%) received DPP-IV inhibitor plus oral antihyperglycemics and 49 (25.5%) received DPP-IV inhibitor plus insulin. Mean daily BG in the entire study population was 158.7 mg/dL (131-187.5). Mean daily BG was significantly different between groups (117 mg/dL [103.5-132.3] vs. 160.7 mg/dL [133-181.1] vs. 179.4 mg/dL [153.8-216.6]; (P < 0.001). Hypoglycemic events were higher in the DPP-IV inhibitor plus insulin group (2.6% vs. 3.8% vs. 16.3%; P = 0.008). There were no significant differences in hospital LOS (2 days [1-4] vs. 3 days [1-5] vs. 4 days [2-6.5]; P = 0.051). Conclusions: Inpatient DPP-IV inhibitor use was associated with mean daily BG within goal range. Administering DPP-IV inhibitors in the inpatient setting should be considered in hospitalized patients with controlled T2DM.

Terapéutica no insulínica para los pacientes hospitalizados con diabetes tipo 2

“…Estudios observacionales han mostrado resultados similares a los ensayos clínicos en la eficacia y seguridad para los inhibidores de la DPP-4 en el ámbito hospitalario. [23][24][25][26] Con respecto de la seguridad con este grupo de medicamentos, saxagliptina y alogliptina han sido asociados con un incremento en las hospitalizaciones por falla cardiaca, por lo que su uso en pacientes con cardiopatía preexistente debe evitarse. 27…”