Add-on DPP4i, GLP1Ra as good as insulin for in-hospital diabetes management

The use of dipeptidyl peptidase 4 inhibitors (DPP4i) and sodium glucose co-transporter 2 inhibitors (SGLT2i) for diabetic patients admitted to hospitals yields the same efficacy and safety outcomes as insulin, according to the results of a systematic review and meta-analysis.

Researchers searched multiple online databases for studies that compared glycaemic control and safety outcomes among hospitalized type 2 diabetes patients who received DPP4i, SGLT2i, or glucagon-like peptide-1 receptor agonist (GLP1Ra) vs insulin.

A total of seven randomized controlled trials (RCTs) and three nonrandomized trials (NRTs) were included in the meta-analysis; three RCTs assessed GLP1Ra with and without insulin in sliding scale as intervention, while four evaluated DPP4i with and without insulin in sliding scale. Two NRTs used DPP4i with insulin in sliding scale as an intervention, and only one study used SGLT2i with insulin in sliding scale.

The most common drug used was linagliptin (three of 10 studies), while the most common insulin regimen was basal-bolus (eight of 10). Mean ages range was 55.7–72.4 years, and mean HbA1c range was 6.6–8.6 percent. Only four studies reported comorbidities, the most prevalent being heart failure and coronary artery disease. Five studies specified the type of patients included (medical vs surgical), with two of them including surgical patients only.

Pooled data revealed no differences between the use of new antidiabetics and the usual insulin regimens in glycaemic control, hypoglycaemia, hyperglycaemia, or adverse events. Of note, there was a discrete benefit in mean blood glucose with GLP1Ra plus sliding scale insulin compared to insulin alone (–16.36 mg/dL, 95 percent confidence interval [CI], –27.31 to –5.41; I2=0 percent), as well as in the incidence of hypoglycaemia <70 mg/dL (relative risk, 0.31, 95 percent CI, 0.14–0.70; I2=0 percent).

Additional randomized studies are required to validate these findings before they could be recommended in clinical practice.