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
Open accessAbstract
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.
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In a 6-month open-label RCT comparing linagliptin with basal insulin glargine in long-term care and skilled nursing facilities, mean daily blood glucose was similar, with fewer hypoglycemic events with linagliptin compared with insulin.
“For example, in a 6-month open-label RCT comparing a DPP-4i (linagliptin) with basal insulin (glargine) in long-term care and skilled nursing facilities, mean daily blood glucose was similar, with fewer hypoglycemic events with linagliptin compared with insulin (181).”
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- Authors
- Umpierrez, G. E., Cardona, S., Chachkhiani, D., Fayfman, M., Saiyed, S., Wang, H., Vellanki, P., Haw, J. S., Olson, D. E., Pasquel, F. J., & Johnson, T. M.
- Affiliations
- Emory University (US)
- Corresponding author
- Umpierrez, Guillermo E.
- ORCID
- Venue
- Journal of the American Medical Directors Association
- Publisher
- Elsevier BV
- Published
- 2018-05
- Volume
- 19
- Issue
- 5
- Pages
- 399-404.e3
- ISSN
- 1525-8610 (ISSN-L)
- PMC
- PMC6093296
- OpenAlex
- W2776839462
- Cited by
- 43
- References
- 40
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 4 · 2023: 2 · 2022: 6 · 2021: 4 · 2020: 7 · 2019: 4 · 2018: 8
- FWCI
- 4.11
- Type
- journal article
- Language
- en
- Update notices
- erratum (2019-07-01)
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Medical Directors Association (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR002378)
- National Institute on Aging (U54AG062334)
- National Institute of Allergy and Infectious Diseases (R38AI140299)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024)
- National Center for Advancing Translational Sciences
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD085850)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Keywords
- linagliptin, DPP-4 inhibitors, basal insulin, glargine, type 2 diabetes, long-term care, skilled nursing facilities, glycemic control, hypoglycemia, HbA1c, rapid-acting insulin, non-inferiority, veterans, older adults, emergency department visits, hospitalization, length of hospital stay, cost-effectiveness
- MeSH terms
- Insulin Glargine, Linagliptin, Aged, Blood Glucose, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Male, Residential Facilities, Skilled Nursing Facilities, Dipeptidyl-Peptidase IV Inhibitors
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