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.
Guillermo E Umpierrez, Saumeth Cardona, David Chachkhiani and 8 others
PMID 29289540WHAT IT FOUND
Average blood glucose did not differ between linagliptin and basal insulin groups in long-term care residents.
The linagliptin group had fewer low blood sugar events. The trial was open-label and had baseline medication differences.
Key findings
01The randomized comparison of linagliptin and glargine, each group possibly receiving metformin and supplemental rapid-acting insulin, showed mean daily blood glucose of 146 mg/dL with linagliptin and 157 mg/dL with glargine, with no statistically significant difference.
02Low blood glucose below 70 mg/dL was less frequent in the linagliptin group than in the glargine group: 27 of 73 glargine participants (37%) had 136 events, versus 2 linagliptin participants (3%) with 3 events.
03Infections, cardiovascular complications, acute kidney injury, emergency department visits, hospital admissions, and mortality were similar between the linagliptin and glargine groups.
STILL TO COME
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What it does not show
Only 140 residents were randomized, and all were from 3 facilities in one geographic area. The trial was open-label, so participants, staff, and investigators knew the assigned treatment. More participants in the linagliptin group had been on oral antidiabetic drugs before randomization (75% vs. 58%), and fewer had been on insulin (6% vs. 25%), which may have influenced glucose control and hypoglycemia. Participants could continue metformin and receive supplemental rapid-acting insulin, so the effect of a single medication component cannot be isolated. The supplied text does not state whether the predefined noninferiority criterion for mean daily blood glucose was met. The study excluded residents with severe kidney or liver disease, pancreatitis, severe hypoglycemia, gastroparesis, and those on insulin above 0.1 U/kg/d, so results do not apply to those groups. Most participants were admitted for subacute rehabilitation or postacute care (117 of 140), not long-term care. Changes in cognitive function were not assessed.
Declared interests
The supplied article text does not report funding or author conflicts of interest. The supplied publication types list NIH and non-U.S. government research support.
The easy way to misread this
Do not conclude that linagliptin should replace basal insulin in all long-term care residents. The main average blood glucose comparison did not show a statistically significant difference, the trial was open-label, and more linagliptin participants had been on oral drugs before randomization.