Transitioning from insulin to dipeptidyl-peptidase 4 (DPP-4) inhibitors for type 2 diabetes

Irene Hamrick; Matthew Joseph Goblirsch; Wen Jan Tuan; Felicia Beckham

doi:10.1016/j.gerinurse.2022.04.023

Transitioning from insulin to dipeptidyl-peptidase 4 (DPP-4) inhibitors for type 2 diabetes

Irene Hamrick, Matthew Joseph Goblirsch, Wen Jan Tuan, Felicia Beckham

Department of Family and Community Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Insulin administration is time intensive and costly in facility staffing. When we started nursing home patients with type 2 diabetes (T2D) on DPP-4 inhibitors, we tapered insulin when finger stick blood sugar levels dropped to <200 mg/dL. Of 34 patients we were able to stop mealtime insulin in 28 (82%) and stop all insulin in 20 (59%). On average, hemoglobin A1c (HbA1c) decreased 0.5% and weight by 2.8 pounds. Among the 20 who stopped all insulin, HbA1c improved in 11 on average 1% (p=0.02), and weight decreased in 11 on average 4.1 pounds (p=0.66). 12 patients were switched in one day because of a low insulin dose or low HbA1c Tapering duration in the other 8 ranged from 10-727 days with an insulin dose of 28 to 84 units daily. Larger studies are needed to confirm our findings, develop a protocol for tapering insulin, and measure hypoglycemia, comfort and cost.

Original language	English (US)
Pages (from-to)	86-89
Number of pages	4
Journal	Geriatric Nursing
Volume	46
DOIs	https://doi.org/10.1016/j.gerinurse.2022.04.023
State	Published - Jul 1 2022

All Science Journal Classification (ASJC) codes

Gerontology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.gerinurse.2022.04.023

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title = "Transitioning from insulin to dipeptidyl-peptidase 4 (DPP-4) inhibitors for type 2 diabetes",

abstract = "Insulin administration is time intensive and costly in facility staffing. When we started nursing home patients with type 2 diabetes (T2D) on DPP-4 inhibitors, we tapered insulin when finger stick blood sugar levels dropped to <200 mg/dL. Of 34 patients we were able to stop mealtime insulin in 28 (82%) and stop all insulin in 20 (59%). On average, hemoglobin A1c (HbA1c) decreased 0.5% and weight by 2.8 pounds. Among the 20 who stopped all insulin, HbA1c improved in 11 on average 1% (p=0.02), and weight decreased in 11 on average 4.1 pounds (p=0.66). 12 patients were switched in one day because of a low insulin dose or low HbA1c Tapering duration in the other 8 ranged from 10-727 days with an insulin dose of 28 to 84 units daily. Larger studies are needed to confirm our findings, develop a protocol for tapering insulin, and measure hypoglycemia, comfort and cost.",

author = "Irene Hamrick and Goblirsch, {Matthew Joseph} and Tuan, {Wen Jan} and Felicia Beckham",

note = "Funding Information: The study was supported by the University's Shapiro Summer student grant to support a student to help with the chart review, analysis and manuscript. Publisher Copyright: {\textcopyright} 2022 The Authors",

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doi = "10.1016/j.gerinurse.2022.04.023",

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AU - Hamrick, Irene

AU - Goblirsch, Matthew Joseph

AU - Tuan, Wen Jan

AU - Beckham, Felicia

N1 - Funding Information: The study was supported by the University's Shapiro Summer student grant to support a student to help with the chart review, analysis and manuscript. Publisher Copyright: © 2022 The Authors

PY - 2022/7/1

Y1 - 2022/7/1

N2 - Insulin administration is time intensive and costly in facility staffing. When we started nursing home patients with type 2 diabetes (T2D) on DPP-4 inhibitors, we tapered insulin when finger stick blood sugar levels dropped to <200 mg/dL. Of 34 patients we were able to stop mealtime insulin in 28 (82%) and stop all insulin in 20 (59%). On average, hemoglobin A1c (HbA1c) decreased 0.5% and weight by 2.8 pounds. Among the 20 who stopped all insulin, HbA1c improved in 11 on average 1% (p=0.02), and weight decreased in 11 on average 4.1 pounds (p=0.66). 12 patients were switched in one day because of a low insulin dose or low HbA1c Tapering duration in the other 8 ranged from 10-727 days with an insulin dose of 28 to 84 units daily. Larger studies are needed to confirm our findings, develop a protocol for tapering insulin, and measure hypoglycemia, comfort and cost.

AB - Insulin administration is time intensive and costly in facility staffing. When we started nursing home patients with type 2 diabetes (T2D) on DPP-4 inhibitors, we tapered insulin when finger stick blood sugar levels dropped to <200 mg/dL. Of 34 patients we were able to stop mealtime insulin in 28 (82%) and stop all insulin in 20 (59%). On average, hemoglobin A1c (HbA1c) decreased 0.5% and weight by 2.8 pounds. Among the 20 who stopped all insulin, HbA1c improved in 11 on average 1% (p=0.02), and weight decreased in 11 on average 4.1 pounds (p=0.66). 12 patients were switched in one day because of a low insulin dose or low HbA1c Tapering duration in the other 8 ranged from 10-727 days with an insulin dose of 28 to 84 units daily. Larger studies are needed to confirm our findings, develop a protocol for tapering insulin, and measure hypoglycemia, comfort and cost.

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Transitioning from insulin to dipeptidyl-peptidase 4 (DPP-4) inhibitors for type 2 diabetes

Abstract

All Science Journal Classification (ASJC) codes

UN SDGs

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