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Vol. 158. Issue 4.
Pages 173-177 (February 2022)
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Vol. 158. Issue 4.
Pages 173-177 (February 2022)
Brief report
Simplified glycaemic management for patients with type 2 diabetes admitted for acute decompensated heart failure using linagliptin
Control glucémico simplificado con linagliptina en pacientes con diabetes mellitus de tipo 2 ingresados por insuficiencia cardíaca descompensada
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Luis M. Pérez-Belmontea,b,c,d,
Corresponding author
luismiguelpb1984@gmail.com

Corresponding author.
, Julio Osuna-Sánchezc,e, Juan Ignacio Rico-Roblesa,b, Michele Riccia, José P. Larac,1, Ricardo Gómez-Huelgasa,f,1
a Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
b Servicio de Medicina Interna, Hospital Helicópteros Sanitarios, Marbella, Spain
c Unidad de Neurofisiología Cognitiva, Centro de Investigaciones Médico Sanitarias (CIMES), Facultad de Medicina, Universidad de Málaga (UMA), Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
d Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
e Servicio de Medicina Interna, Hospital Comarcal de La Axarquía, Vélez-Málaga, Málaga, Spain
f Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
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Tables (2)
Table 1. Sociodemographic, anthropometric, diabetes, heart failure, and previous medical history data of patients admitted for acute decompensated heart failure according to antihyperglycemic regimen: pre- and post-propensity matching analysis.
Table 2. Glycaemic control, insulin therapy, hypoglycaemia, length of hospital stay, and hospital complications outcomes of patients admitted for acute decompensated heart failure by antihyperglycaemic regimen: pre- and post-propensity matching analysis.
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Abstract
Introduction and objectives

Hyperglycaemia in hospitalized patients with type 2 diabetes is preferably managed with insulin. We aimed to analyse the glycaemic efficacy, treatment simplicity, and safety of our hospital's antihyperglycemic regimens (linagliptin-basal insulin versus basal-bolus insulin) in patients with type 2 diabetes admitted for heart failure decompensation.

Patients and methods

In this real-world study, we included patients with mild-to-moderate hyperglycaemia managed with our antihyperglycemic regimens between 2016 and 2018. To match patients who started one of the regimens, a propensity matching analysis was used.

Results

After propensity matching, 146 patients were included in each group. There were no differences in mean blood glucose levels (163.6±21.2 vs 159.6±19.2mg/dl, p=.210). Patients on the linagliptin-basal insulin regimen had a lower total number of hypoglycaemic episodes (36 vs 64, p<.001), lower total insulin dose (24.1±5.3 vs 32.0±5.6 units, p<.001), and lower number of daily injections (2.4±.8 vs 4.0±.0, p<.001) than those on the basal-bolus regimen.

Conclusions

Linagliptin-basal insulin was a safe, simple, and efficacious regimen and could be considered standard of care for these vulnerable, high complex patients to simplify in-hospital management.

Keywords:
Type 2 diabetes
Heart failure
Linagliptin
Hospitalization
Hyperglycaemia
Resumen
Fundamentos y objetivos

La hiperglucemia hospitalaria se maneja preferiblemente con insulina. Nuestro objetivo fue analizar la eficacia glucémica, simplificación del tratamiento y seguridad de los regímenes hospitalarios de manejo de la hiperglucemia (insulina basal-linagliptina versus insulina basal-bolo) en pacientes con diabetes mellitus de tipo 2 ingresados por insuficiencia cardíaca descompensada.

Material y métodos

En este estudio de vida real, se incluyó a pacientes con hiperglucemia leve/moderada manejados con nuestros regímenes entre 2016 y 2018. Para emparejar a los pacientes que comenzaban alguno de los regímenes se usó un análisis de propensiones.

Resultados

Tras el análisis de propensiones, 146 pacientes fueron incluidos en cada grupo. No hubo diferencias en los niveles de glucosa medios (163,6±21,2 vs. 159,6±19,2mg/dl; p=0,210). Los pacientes con el régimen de insulina basal-linagliptina tuvieron menos hipoglucemias (36 vs. 64; p<0,001), menos insulina total (24,1±5,3 vs. 32±5,6 unidades; p<0,001) y menos inyecciones diarias (2,4±0,8 vs. 4±0; p<0,001) que los pacientes del régimen basal-bolo.

Conclusiones

El régimen de insulina basal-linagliptina fue seguro, simple y eficaz y podría ser considerado como tratamiento de referencia para estos pacientes vulnerables y con alta complejidad clínica, con lo que se simplificaría el manejo hospitalario.

Palabras clave:
Diabetes mellitus de tipo 2
Insuficiencia cardíaca
Linagliptina
Hospitalización
Hiperglucemia

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