How to Cite
Abstract
Introduction: Type 2 diabetes mellitus is a disease with a high prevalence worldwide and its incidence increases, so it is frequent that patients who are hospitalized for various causes have diabetes. In this population group, the American Diabetes Association (ADA) recommends insulin as the drug of choice, despite the fact that they receive other antidiabetic drugs in their outpatient treatment. Therefore, the objective of this study is to evaluate the non-inferiority of drugs with incretin effect (IV dipeptidyl peptidase inhibitors and GLP-1 agonists) when compared with insulin in the hospital setting.
Methodology: A systematic review of the literature and meta-analysis we were carried out. The literature search was carried out in the Pubmed, Embase, Science direct, Scielo, Scopus, Open Gray and Google scholar databases. Randomized clinical trials were included comparing treatment with drugs with incretin effect vs basal bolus insulin regimen in hospitalized patients. The primary outcome was glycemic control (normoglycemia) and as secondary outcomes hyper or hypoglycemia. Odds Ratios (ORs) were calculated as measures of association with their 95% confidence intervals and I2 indices in each analysis as a measure of heterogeneity, using the Review Manager software. For interpretation, 1.25 was arbitrarily set as the non-inferiority limit.
Results: 116 references were identified as possibly eligible and 7 studies were included. Five of them compared DPP-4 inhibitors vs insulin and 2 with GLP-1 agonists vs insulin. The OR for normoglycemia was 1.35 (95% CI 1.27-1.42, I2 = 95%) when comparing incretin drug (both types) vs insulin, while for the comparator incretin drug associated with insulin vs insulin it was 1.5 (95% CI 1.00 -2.27, I2 = 95%). For hyperglycemia in both comparisons, the OR were 0.81 (95% CI 0.63-1.04, I2 = 84%) and 0.63 (95% CI 0.50-0.80, I2 = 81%), respectively. In the hypoglycemic outcome, the OR was 0.15 (95% CI 0.06 to 0.4, I2 = 23%) for incretin drug vs insulin and 0.44 (95% CI 0.18-1.06, I2 = 50%) for incretin drug associated with insulin vs insulin.
Conclusion: incretin drugs were inferior to insulin for the outcome of normoglycemia in hospitalized diabetic patients. In contrast, they were not inferior with respect to hyperglycemia and hypoglycemia outcomes. Further studies are required to get a recommendation for the use of these drugs in the hospital setting.
References
Dennis K, Fauci A, Hauser S, Longo D, Jameson JL LJ. Harrison’s Principles of Internal Medicine . 19th ed. McGraw-Hill Medical
World Health Organization. Global report on diabetes WHO Library Cataloguing-in-Publication Data. ISBN . 2016 [cited 2017 Sep 27];978:92–4.
Mata-cases M, Artola S, Conthe P, Mediavilla J. Abordaje de la adherencia en diabetes mellitus tipo 2: situación actual y propuesta de posibles soluciones. Aten Primaria. 2016;48(6):406–20.
Centers for Disease Control. National Diabetes Statistics Report, 2017 Estimates of Diabetes and Its Burden in the United States Background. 2017 [citado el 27 de septiembre de 2017]; Disponible en: http://www.diabetes.org/assets/pdfs/basics/cdc-statistics-report-2017.pdf
Cuenta de Alto Costo- Fondo Colombiano de Enfermedades de Alto Costo. La enfermedad renal crónica en crónica, la hipertensión arterial y la diabetes mellitus en Colombia . Bogotá, Colombia; 2016.
Aschner P. Epidemiología de la diabetes en Colombia. 2010;26:95–100.
Wallia A, Molitch ME. Insulin Therapy for Type 2 Diabetes Mellitus. JAMA . 2014 Jun 11 [cited 2017 Sep 27];311(22):2315.
Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care . 2009;32(6):1119–31.
American Diabetes Association AD. 13. Diabetes Care in the Hospital. Diabetes Care . 2016 Jan 1 [cited 2017 Oct 28];39 Suppl 1(Supplement 1):S99-104.
Stuart K, Adderley NJ, Marshall T, Rayman G, Sitch A, Manley S, et al. Predicting inpatient hypoglycaemia in hospitalized patients with diabetes: a retrospective analysis of 9584 admissions with diabetes. Diabet Med . 2017; 34(10):1385–91.
Macdonald JJ, Neupane S, Gianchandani RY. The potential role of incretin therapy in the hospital setting. Clin Diabetes Endocrinol. 2015; 1(1):4.
Drucker DJ. Therapeutic potential of dipeptidyl peptidase IV inhibitors for the treatment of type 2 diabetes. Expert Opin Investig Drugs . 2003;12(1):87–100.
Aylwin H. CG. Nuevos Fármacos en Diabetes Mellitus. Rev Médica Clínica Las Condes. 2016 Mar;27(2):235–56.
Garg R, Schuman B, Hurwitz S, Metzger C, Bhandari S. Safety and efficacy of saxagliptin for glycemic control in non-critically ill hospitalized patients. BMJ open diabetes Res care. 2017; 5(1):e000394.
Umpierrez GE, Gianchandani R, Smiley D, Jacobs S, Wesorick DH, Newton C, et al. Safety and efficacy of sitagliptin therapy for the inpatient management of general medicine and surgery patients with type 2 diabetes: a pilot, randomized, controlled study. Diabetes Care . 2013; 36(11):3430–5.
Umpierrez GE, Cardona S, Chachkhiani D, Fayfman M, Saiyed S, Wang H, et al. A Randomized Controlled Study Comparing a DPP4 Inhibitor (Linagliptin) and Basal Insulin (Glargine) in Patients With Type 2 Diabetes in Long-term Care and Skilled Nursing Facilities: Linagliptin-LTC Trial. J Am Med Dir Assoc. 2018; 19(5):399-404.e3.
Pasquel FJ, Gianchandani R, Rubin DJ, Dungan KM, Anzola I, Gomez PC, et al. Efficacy of sitagliptin for the hospital management of general medicine and surgery patients with type 2 diabetes (Sita-Hospital): a multicentre, prospective, open-label, non-inferiority randomised trial. lancet Diabetes Endocrinol. 2017;5(2):125–33.
Vellanki P, Rasouli N, Baldwin D, Alexanian S, Anzola I, Urrutia M, et al. Glycaemic efficacy and safety of linagliptin compared to a basal-bolus insulin regimen in patients with type 2 diabetes undergoing non-cardiac surgery: A multicentre randomized clinical trial. Diabetes, Obes Metab. 2019;21(4):837–43.
Fushimi N, Shibuya T, Yoshida Y, Ito S, Hachiya H, Mori A. Dulaglutide-combined basal plus correction insulin therapy contributes to ideal glycemic control in non-critical hospitalized patients. J Diabetes Investig . 2019
Fayfman M, Galindo RJ, Rubin DJ, Mize DL, Anzola I, Urrutia MA, et al. A Randomized Controlled Trial on the Safety and Efficacy of Exenatide Therapy for the Inpatient Management of General Medicine and Surgery Patients With Type 2 Diabetes. Diabetes Care . 2019; 42(3):450–6.
Johnson EL, Feldman H, Butts A, Billy CDR, Dugan J, Leal S, et al. Standards of medical care in diabetes—2019 abridged for primary care providers. Clin Diabetes. 2019 Jan 1;37(1):11–34.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2022 Revista Colombiana de Endocrinología, Diabetes & Metabolismo