Substitution of Chronic Insulin Therapy with Dipeptidyl Peptidase-4 Inhibitors and Sodium-Glucose Co-transporter-2 Inhibitors.
Insulin is a very useful and widely used treatment for diabetes. Temporary insulin therapy
improves glucose toxicity due to improved β-cell function of the pancreas.
Upon achieving glycemic control, insulin treatment could be discontinued and substituted
with oral hypoglycemic agents. Nevertheless, insulin therapy is associated with side effects
such as hypoglycemia, allergic reactions, and angioneurotic edema.
Over this past decade, there have been rapid advances in diabetes treatment, including
the introduction of Dipeptidyl peptidase-4 (DPP-4) inhibitors and Sodium-glucose
cotransporter-2 (SGLT2) inhibitors.
We present here the case of a patient with type 2 diabetes who discontinued insulin
therapy after more than 20 years by switching to oral hypoglycemic agents including
a DPP-4 inhibitor and a SGLT2 inhibitor.
A 64-year-old man with type 2 diabetes was being treated with Lispro Mix 50 insulin
twice daily. He was started on subcutaneous insulin 20 years ago. He also has hypertension and
hyperlipidemia, and visits the home clinic once a month.
Serum C-peptide and HbA1c were 0.9 ng/ml and 7.3% respectively three months later.
In theory, the dose of insulin should be reduced gradually when oral hypoglycemic
agents are added and insulin therapy is being discontinued.
However, the patient demanded immediate discontinuation of insulin therapy.
Since his insulin dose was relatively low, 0.3 U/ kg, insulin was discontinued,
and oral hypoglycemic agents were started at once after a comprehensive
review of the risks and benefits of a sudden change in therapy.
Diabetes Res Open J. 2015; 1(3): 77-78. doi: 10.17140/DROJ-1-113
