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

作者：Umpierrez Guillermo E; Cardona Saumeth; Chachkhiani David; Fayfman Maya; Saiyed Sahebi; Wang Heqiong; Vellanki Priyathama; Haw J Sonya; Olson Darin E; Pasquel Francisco J; Johnson Theodore M

来源：Journal of the American Medical Directors Association, 2018, 19(5): 399-+.

DOI：10.1016/j.jamda.2017.11.002

• Incretin
• DPP4 inhibitors
• long-term care
• nursing home
• skilled nursing facilities
• glargine
• linagliptin
• basal insulin
• hospital hyperglycemia
• older adults
• diabetes

Objectives: Safe and easily implemented treatment regimens are needed for the management of patients with type 2 diabetes mellitus (T2DM) in long-term care (LTC) and skilled nursing facilities.
Design: This 6-month open-label randomized controlled trial compared the efficacy and safety of a DPP4 inhibitor (linagliptin) and basal insulin (glargine) in LTC residents with T2DM.
Settings: Three LTC institutions affiliated with a community safety-net hospital, US Department of Veterans Affairs and Emory Healthcare System in Atlanta, Georgia.
Participants: A total of 140 residents with T2DM treated with oral antidiabetic agents or low-dose insulin (< 0.1 U/kg/d), with fasting or premeal blood glucose (BG) > 180 mg/dL and/or HbA1c > 7.5%.
Intervention: Baseline antidiabetic therapy, except metformin, was discontinued on trial entry. Residents were treated with linagliptin 5 mg/d (n = 67) or glargine at a starting dose of 0.1 U/kg/d (n = 73). Both groups received supplemental rapid-acting insulin before meals for BG > 200 mg/dL.
Measurements: Primary outcome was mean difference in daily BG between groups. Main secondary endpoints included differences in frequency of hypoglycemia, glycosylated hemoglobin (HbA1c), complications, emergency department visits, and hospital transfers.
Results: Treatment with linagliptin resulted in no significant differences in mean daily BG (146 +/- 34 mg/dL vs. 157 +/- 36 mg/dL, P = .07) compared to glargine. Linagliptin treatment resulted in fewer mild hypoglycemic events < 70 mg/dL (3% vs. 37%, P < .001), but there were no differences in BG < 54 mg/dL (P = .06) or < 40 mg/dL (P = .05) compared to glargine. There were no significant between-group differences in HbA1c, length of stay, complications, emergency department visits, or hospitalizations.
Conclusion: Treatment with linagliptin resulted in noninferior glycemic control and in significantly lower risk of hypoglycemia compared to insulin glargine in long-term care and skilled nursing facility residents with type 2 diabetes.

• 出版日期2018-5