Glycaemic efficacy and safety of linagliptin for the management of non-cardiac surgery patients with type 2 diabetes in a real-world setting: Lina-surg study
Open accessAbstract
Introduction: The use of dipeptidyl peptidase-4 inhibitors in hospitalized patients is an area of active research. We aimed to compare the efficacy and the safety of the basal-bolus insulin regimen versus linagliptin-basal insulin in non-critically ill non-cardiac surgery patients in a real-world setting.Methods: We enrolled patients with type 2 diabetes hospitalized in non-cardiac surgery departments with admission glycated haemoglobin level < 8%, admission blood glucose concentration < 240 mg/dL, and no at-home injectable treatments who were treated with basal-bolus (n = 347) or linagliptin-basal (n = 190) regimens between January 2016 and December 2017. To match patients on the two regimens, a propensity matching analysis was performed.Results: After matching, 120 patients were included in each group. No differences were noted in mean blood glucose concentration after admission (p = .162), number of patients with a mean blood glucose 100–140 mg/dL (p = .163) and > 200 mg/dL (p = .199), and treatment failures (p = .395). Total daily insulin and number of daily insulin injections were lower in the linagliptin-basal group (both p < .001). Patients on linagliptin-basal insulin had fewer hypoglycaemic events (blood glucose < 70 mg/dL) (p < .001).Conclusion: For type 2 diabetes surgery patients with mild to moderate hyperglycaemia without pre-hospitalization injectable therapies, linagliptin-basal insulin was an effective, safe alternative with fewer hypoglycaemic events in real-world practice.Key messagesTreatment with basal-bolus insulin regimens is the standard of care for non-critically ill hospitalized patients with type 2 diabetes.A differentiated treatment protocol that takes into account glycaemic control and clinical factors should be implemented in the hospital setting.Linagliptin-basal insulin is an effective, safe alternative with fewer hypoglycaemic events during the hospitalization of non-critically ill non-cardiac surgery patients with T2D in real-world practice.
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In a single-center RCT, correctional insulin sliding scales for bedtime hyperglycemia did not improve glycemic control in T2D patients.
“In a single-center RCT, the use of correctional insulin sliding scales for bedtime hyperglycemia did not improve glycemic control in persons with T2D.1341,1342”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1342]
The Study design and hospital antihyperglycaemic protocol section describes supplemental rapid-acting insulin before meals and bedtime, but does not test bedtime correctional insulin against a no-correction group. The Results compare linagliptin–basal with basal-bolus treatment, not the effect of bedtime sliding scales. Searches for a single-center randomized trial and bedtime correctional insulin did not locate the claimed finding in our copy; page numbers were not available. (LLM, conf=0.76)
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References 27 · Cited by 36
- Authors
- Pérez-Belmonte, L. M., Osuna-Sánchez, J., Millán-Gómez, M., López-Carmona, M. D., Gómez-Doblas, J. J., Cobos-Palacios, L., Sanz-Cánovas, J., Barbancho, M. A., Lara, J. P., Jiménez-Navarro, M., Bernal-López, M. R., & Gómez-Huelgas, R.
- Affiliations
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain;
- Servicio de Medicina Interna, Hospital Comarcal de Melilla, Melilla, Spain;
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain;
- Hospital Regional Universitario de Málaga (ES)
- Unidad de Neurofisiología Cognitiva, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Campus de Excelencia Internacional (CEI) Andalucía Tech, Málaga, Spain;
- Instituto de Investigación Biomédica de Málaga (ES)
- Instituto de Salud Carlos III (ES)
- Venue
- Annals of Medicine
- Publisher
- Informa UK Limited
- Published
- 2019-05-19
- Volume
- 51
- Issue
- 3-4
- Pages
- 252-261
- ISSN
- 0785-3890 (ISSN-L)
- 1365-2060
- PMC
- PMC7877876
- OpenAlex
- W2943662632
- Cited by
- 36
- References
- 27
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 5 · 2023: 5 · 2022: 8 · 2021: 5 · 2020: 7 · 2019: 2
- FWCI
- 4.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Annals of Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
- Funders
- Fondo Europeo de Desarrollo Regional-FEDER (CB06/03/0018)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- linagliptin, type 2 diabetes, non-cardiac surgery, multiple daily insulin injections, DPP-4 inhibitors, glycemic control, hypoglycemia, hospitalized patients, hyperglycemia, insulin dose reduction, real-world evidence
- MeSH terms
- Linagliptin, Aged, Blood Glucose, Diabetes Mellitus, Type 2, Drug Therapy, Combination, Female, Glycated Hemoglobin, Hospitalization, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Male, Middle Aged, Safety, Spain, Treatment Outcome, Treatment Failure, Dipeptidyl-Peptidase IV Inhibitors
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