Switching from Premixed Insulin To Basal Insulin Analogue For Type 2 Diabetes and Role of Dipeptidyl Peptidase-4 Inhibitors

Introduction This study aimed to confirm the usefulness of basal insulin analogue plus oral antidiabetic drugs (OADs) for type 2 diabetes (T2D) patients inadeguately controlled with premixed insulin with/without OADs and assess the role of dipeptidyl peptidase-4 (DPP-4) inhibitors within this regimen in clinical practice. Methods Spanish retrospective observational study that included 186 T2D patients with glycosylated hemoglobin (HbA1 c) >7 % (53 mmol/mol) despite premixed insulin with/ without OADs who had been switched to basal insulin analogue plus OADs. Study data describing the situation before the treatment switch and 6 months later was retrospectively retrieved from patients' medical charts. Results Switching to a basal insulin plus OADs decreased HbA1 c (-1.0%, p< 0.001), fasting (-38.1 mg/dl, p< 0.001) and postprandial glycemia (-36.1 mg/dl, p<0.001), with reduced body weight (- 1.1 kg, p < 0.001) and hypoglycemic episodes (- 17.5 %, p<0.001). 68 (36.6 %) patients received a basal insulin plus DPP-4 inhibitor +/- metformin and 74 (39.8%) plus metformin only. The DPP-4 inhibitor +/- metformin group showed a greater HbA1 c reduction than the metformin group (1.3 +/- 1.4% vs. 0.9 +/- 1.0 %, p = 0.022), with no significant differences between groups in hypoglycemic episodes. Conclusions Basal insulin analogue plus OADs may be a useful treatmentfortype 2 diabetes patients inadeguately controlled with premixed insulin. Administering DPP-4 inhibitors within this regimen may contribute to improve patients' glycemia, with a favorable weight-change profile and without increasing hypoglycemia risk.