Lorenzo-González Cristina, Atienza-Sánchez Elena, Reyes-Umpierrez David, Vellanki Priyathama, Davis Georgia M, Pasquel Francisco J, Cardona Saumeth, Fayfman Maya, Peng Limin, Umpierrez Guillermo E
Department of Endocrinology and Nutrition, Hospital Universitario Nuestra Señora de La Candelaria, Tenerife, Spain.
Department of Endocrinology and Nutrition, Hospital Universitario Príncipe de Asturias, Madrid, Spain.
Endocr Pract. 2020 Jul;26(7):722-728. doi: 10.4158/EP-2019-0481. Epub 2020 Nov 24.
DPP-4 inhibitors (DPP-4i) have been shown to be effective for the management of inpatient diabetes. We report pooled data from 3 prospective studies using DPP-4i in general medicine and surgery patients with type 2 diabetes (T2D).
We combined data from 3 randomized studies comparing DPP-4i alone or in combination with basal insulin or a basal-bolus insulin regimen. Medicine (n = 266) and surgery (n = 319) patients admitted with a blood glucose (BG) between 140 and 400 mg/dL, treated with diet, oral agents, or low-dose insulin therapy were included. Patients received DPP-4i alone (n = 144), DPP-4i plus basal insulin (n = 158) or basal-bolus regimen (n = 283). All groups received correctional doses with rapid-acting insulin for BG >140 mg/dL. The primary endpoint was differences in mean daily BG between groups. Secondary endpoints included differences in hypoglycemia and hospital complications.
There were no differences in mean hospital daily BG among patients treated with DPP-4i alone (170 ± 37 mg/dL), DPP-4i plus basal (172 ± 42 mg/dL), or basalbolus (172 ± 43 mg/dL), P = .94; or in the percentage of BG readings within target of 70 to 180 mg/dL (63 ± 32%, 60 ± 31%, and 64 ± 28%, respectively; P = .42). There were no differences in length of stay or complications, but hypoglycemia was less common with DPP-4i alone (2%) compared to DPP-4i plus basal (9%) and basal-bolus (10%); P = .004.
Treatment with DPP-4i alone or in combination with basal insulin is effective and results in a lower incidence of hypoglycemia compared to a basal-bolus insulin regimen in general medicine and surgery patients with T2D.
BG = blood glucose; BMI = body mass index; CI = confidence interval; DPP-4i = dipeptidyl peptidase-4 inhibitors; HbA1c = hemoglobin A1c; OR = odds ratio; T2D = type 2 diabetes.
二肽基肽酶-4抑制剂（DPP-4i）已被证明对住院糖尿病患者的管理有效。我们报告了3项前瞻性研究的汇总数据，这些研究在普通内科和外科的2型糖尿病（T2D）患者中使用了DPP-4i。
我们合并了3项随机研究的数据，这些研究比较了单独使用DPP-4i或与基础胰岛素或基础-餐时胰岛素方案联合使用的情况。纳入血糖（BG）在140至400mg/dL之间、接受饮食、口服药物或低剂量胰岛素治疗的内科患者（n = 266）和外科患者（n = 319）。患者单独接受DPP-4i（n = 144）、DPP-4i加基础胰岛素（n = 158）或基础-餐时方案（n = 283）。所有组在BG>140mg/dL时接受速效胰岛素的校正剂量。主要终点是各组之间平均每日BG的差异。次要终点包括低血糖和医院并发症的差异。
单独使用DPP-4i治疗的患者（170±37mg/dL）、DPP-4i加基础胰岛素治疗的患者（172±42mg/dL）或基础-餐时方案治疗的患者（172±43mg/dL）之间，平均每日住院BG无差异，P = 0.94；BG读数在70至180mg/dL目标范围内的百分比也无差异（分别为63±32%、60±31%和64±28%；P = 0.42）。住院时间或并发症方面无差异，但单独使用DPP-4i时低血糖的发生率较低（2%），而DPP-4i加基础胰岛素时为（9%），基础-餐时方案时为（10%）；P = 0.004。
在普通内科和外科的T2D患者中，单独使用DPP-4i或与基础胰岛素联合使用是有效的，与基础-餐时胰岛素方案相比，低血糖发生率更低。
BG = 血糖；BMI = 体重指数；CI = 置信区间；DPP-4i = 二肽基肽酶-4抑制剂；HbA1c = 糖化血红蛋白；OR = 比值比；T2D = 2型糖尿病
