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.