Sitagliptin with basal-plus insulin regimen more effective than insulin therapy alone for type 2 diabetes: Study

The study revealed that the sitagliptin and BP regimen combination is safe and more effective than insulin therapy alone for inpatients with type 2 diabetes and hyperglycemia.

"Combining sitagliptin with a basal-plus insulin regimen leads to a comparable risk of hypoglycemia, lower daily blood glucose levels, and lower insulin doses than the basal-plus regimen alone," the researchers reported.

The recommended method for insulin administration is a basal-bolus regimen, which involves the daily subcutaneous injection of basal insulin, along with rapid-acting insulin before meals for prandial and correctional doses. However, its application is limited by the complexity of this approach and the risk of hypoglycemia.

Previous studies have revealed that basal and correctional insulin doses (basal-plus regimen) with sitagliptin are similar to the basal-bolus insulin regimen in hyperglycemia management in a hospital setting. However, no clarity exists on whether this combination is better than a basal-plus regimen alone. Therefore, Abraham Edgar Gracia-Ramos, Instituto Mexicano del Seguro Social, Mexico City, Mexico, and colleagues aimed to compare the safety and efficacy of basal-plus insulin regimen with or without sitagliptin in non-critically ill patients with type 2 diabetes.

For this purpose, the researchers conducted an open-label, randomized clinical trial comprising patients with a previous diagnosis of T2D and blood glucose (BG) between 180 and 400 mg/dL. Participants received basal and correctional insulin doses (BP regimen) either with or without sitagliptin. The study's primary outcome was the difference in the mean daily blood glucose among the groups. Seventy-six patients (mean age 60 years, 64 % men) were randomized.

Based on the study, the researchers reported the following findings:

• Compared with BP insulin therapy alone, the sitagliptin-BP combination led to a lower mean daily BG (158.8 versus 175.0 mg/dL), a higher percentage of readings within a BG range of 70–180 mg/dL (75.9 % versus 64.7 %), and a lower number of BG readings >180 mg/dL.
• Sitagliptin-BP resulted in fewer basal and supplementary insulin doses and lower daily insulin injections than those with insulin alone.
• The proportion of patients with hypoglycemia was similar in the two groups.

"These results are significant because using DPP-4 inhibitors with basal-plus insulin therapy simplifies hospital diabetes management for healthcare professionals, improves treatment adherence, and leads to better patient outcomes," the researchers wrote.

Reference:

Gracia-Ramos, A. E., Cruz-Dominguez, M. D. P., Madrigal-Santillán, E. O., Rojas-Martínez, R., Morales-González, J. A., Morales-González, Á., Hernández-Espinoza, M., Vargas-Peñafiel, J., & Tapia-González, M. D. L. Á. (2024). Efficacy and safety of sitagliptin with basal-plus insulin regimen versus insulin alone in non-critically ill hospitalized patients with type 2 diabetes: SITA-PLUS hospital trial. Journal of Diabetes and its Complications, 38(5), 108742. https://doi.org/10.1016/j.jdiacomp.2024.108742