Management of hospitalized older adults (> 65 years) with T2D is challenging and associated with increased risk of hypoglycemia. Incretin-based therapy with DPP-4i and GLP-1RA have been shown to be safe and efficacious in hospitalized patients with mild-moderate hyperglycemia. We performed a post hoc pooled analysis of 4 randomized controlled trials comparing DPP-4i and GLP-1RA alone or in combination with basal insulin to basal-bolus regimen in older adults in non-ICU settings. The primary endpoint was percentage of BG readings within target range (70-180 mg/dL). Secondary endpoints included mean hospital BG, hypoglycemia and a composite of hospital complications.
Among a total of 192 elderly patients, 88 (45.8%) received basal+bolus, 52 (27%) incretin+basal, and 52 (27%) incretin therapy alone. All treatment groups had improvement in glycemic control with no differences in % BG between 70-180 mg/dL or in the mean daily BG, or hospital complications between groups (Table). Patients treated with basal+bolus insulin had the highest rate of hypoglycemia. No differences were found on % of BG readings within range of 70-180 mg/dl (primary outcome) for patients with randomization BG ≤ 200 mg/dL or BG > 200 mg/dl.
M. Fayfman: None. I. Anzola: None. M.A. Urrutia: None. F.J. Pasquel: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck & Co., Inc. R.J. Galindo: Advisory Panel; Self; Abbott, Novo Nordisk Inc., Sanofi US. Research Support; Self; Novo Nordisk Inc. S. Cardona: None. H. Wang: None. G.E. Umpierrez: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc. Research Support; Self; AstraZeneca, Merck & Co., Inc., Novo Nordisk Inc., Sanofi US.
