title: Identification of predictors of response to basal insulin and DPP4 inhibitors in patients with type 2 diabetes failing to other therapies.
abstract: OBJECTIVE
  Basal insulin and DPP4 inhibitors are both possible options in patients with type 2 diabetes failing to oral drugs. The identification of clinical predictors of success with either one of the two approaches could be of help in personalizing therapy.
  
  
  METHODS
  The retrospective study was performed on a consecutive series of patients with type 2 diabetes (n = 1,002) failing to at least one oral agent, who had been prescribed either basal insulin or DPP4 inhibitors in the previous 2 years, with a duration of follow-up of at least 6 months. Clinical predictors of success after 6 months from the beginning of second-line treatment were identified in the cohort.
  
  
  RESULTS
  Among patients receiving a prescription of basal insulin, the proportion of therapeutic success at 6 months was 26.5 %. At multivariate analysis, a higher age and BMI, and a lower duration of diabetes were associated with success, as well as treatment with acarbose; conversely, a history of ischemic heart disease was associated with failure. Prescription of DPP4 inhibitors produced a therapeutic success in 24.8 % of cases. At multivariate analysis, success was associated with a lower baseline HbA1c and duration of diabetes, and a higher BMI and comorbidity; in addition, a lower success rate was found in women after adjusting for other confounders.
  
  
  CONCLUSIONS
  The present data support the view that insulin treatment is preferable in patients with severe hyperglycemia, failing to one or more drugs, whereas DPP4 inhibitors appear to be more useful in those with comorbid conditions.
authors: Division of Geriatric Cardiology and Medicine, Azienda Ospedaliero-Universitaria Careggi, Via delle Oblate 4, 50141, Florence, Italy. mmonami@libero.it.
authors: Matteo
authors: M
authors: Monami
authors: Diabetes Agency, Careggi Teaching Hospital, Florence, Italy.
authors: Benedetta
authors: B
authors: Ragghianti
authors: Division of Geriatric Cardiology and Medicine, Azienda Ospedaliero-Universitaria Careggi, Via delle Oblate 4, 50141, Florence, Italy.
authors: Stefania
authors: S
authors: Zannoni
authors: Diabetes Agency, Careggi Teaching Hospital, Florence, Italy.
authors: Valentina
authors: V
authors: Vitale
authors: Division of Geriatric Cardiology and Medicine, Azienda Ospedaliero-Universitaria Careggi, Via delle Oblate 4, 50141, Florence, Italy.
authors: Besmir
authors: B
authors: Nreu
authors: Diabetes Agency, Careggi Teaching Hospital, Florence, Italy.
authors: Edoardo
authors: E
authors: Mannucci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use*; D004351:Drug Resistance / Q000187:drug effects; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000069057:Insulin Detemir / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D000069057:Insulin Detemir
keywords: DPP4 inhibitors; Diabetes; Insulin; Predictors of success