Linagliptin in combination with insulin
In a double-blind 24-week study, addition of linagliptin to insulin (with or without concomitant metformin and/or pioglitazone), provided a significant -0.65% improvement in HbA1c compared with placebo, from a mean baseline of 8.3%. A similar improvement in HbA1c versus placebo was seen in a double-blind 24-week study in elderly patients (≥70 years) receiving linagliptin in addition to metformin and/or sulfonylurea and/or insulin: -0.64%, from a baseline of 7.8%.
Vildagliptin plus insulin
A randomised, double-blind 24-week trial showed that vildagliptin significantly reduced HbA1c in patients receiving a stable dose of basal or premixed insulin (n=449). The placebo-adjusted mean HbA1c reduction in the overall study population was -0.72% from a mean baseline of 8.8%. In patients receiving and patients not receiving concomitant metformin the reductions were 0.63% and 0.84%, respectively.
In another 24-week study in patients with more advanced type 2 diabetes not adequately controlled on insulin, addition of vildagliptin produced a significantly greater mean reduction in HbA1c than addition of placebo (0.5% vs 0.2%).
Vildagliptin plus metformin and a sulfonylurea
A randomised, double-blind 24-week trial in 318 patients showed that vildagliptin in combination with metformin and glimepiride significantly decreased HbA1c, with a placebo-adjusted mean reduction of 0.76% from a mean baseline HbA1c of 8.8%.
Consider reducing sulfonylurea dose when used with DPP4 inhibitor
When DPP4 inhibitors are used in combination with insulin or a sulfonylurea, a lower dose of the sulfonylurea or insulin may be needed to reduce the risk of hypoglycaemia.