In-hospital linagliptin for management simplification and hypoglycemia reduction in very old patients with type 2 diabetes.

Abstract

Introduction and objectives: The role of in-hospital dipeptidyl peptidase-4 inhibitors in very old patients has not been widely described. This work analyzes the simplification of in-hospital antihyperglycemic management (less insulin use) and reductions in hypoglycemia events using linagliptin in patients aged≥80 years with type 2 diabetes.

Patients and methods: This real-world observational study included hospitalized patients≥80 years with type 2 diabetes treated with an antihyperglycemic protocol of either basal-bolus insulin or linagliptin between January 2016 and December 2023. A 1:1 propensity score matching analysis was performed.

Results: Post-matching, 944 patients were included in each group. The total and basal insulin doses and number of daily injections were significantly lower in the linagliptin group than the basal-bolus insulin group with no differences in glycemic efficacy. Regarding safety, patients on the basal-bolus insulin regimen had more hypoglycemic events. The use of basal-bolus insulin regimen (odds ratio: 4.22; 95% confidence interval: 2.14-6.28; p<0.001), a higher total insulin dose (odds ratio: 3.55; 95% confidence interval: 2.02-5.36; p<0.001) and the number of insulin injections (odds ratio: 2.86; 95% confidence interval: 1.50-4.12; p=0.002) were associated with a greater risk of hypoglycemia. Other hypoglycemia risk factors were older age, moderate-severe functional dependence, moderate-severe dementia, polypharmacy, and complex health status.

Conclusions: The linagliptin regimen simplified in-hospital antihyperglycemic management and reduced hypoglycemia events compared to basal-bolus insulin regimen in patients with type 2 diabetes aged≥80 years. Basal-bolus insulin use and clinical factors were associated with hypoglycemia. The linagliptin regimen could be considered as standard of care for older adult type 2 diabetes patients in the hospital setting.