Hypoglycemic Events During Hospitalization in Diabetic Acute Coronary Syndrome Patients Treated with Vildagliptin vs. Guidelines Based Medical Therapy

Idit Dr. Dobrecky-Mery Departement of Cardiology, Bnai-Zion Medical Center, Haifa, Israel Adir Sommer The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel Nadia Nahmany Goldberg Departement of Cardiology, Bnai-Zion Medical Center, Haifa, Israel Eugeny Dr. Radizishevsky Departement of Cardiology, Bnai-Zion Medical Center, Haifa, Israel Elena Dr. Rivlin Departement of Cardiology, Bnai-Zion Medical Center, Haifa, Israel Hammoud Dr. Mahmod Departement of Cardiology, Bnai-Zion Medical Center, Haifa, Israel Zaid Dr. Gassan Departement of Cardiology, Bnai-Zion Medical Center, Haifa, Israel Ghanayim Dr. Mustafa Departement of Cardiology, Bnai-Zion Medical Center, Haifa, Israel Uri Prof. Rosenschein Departement of Cardiology, Bnai-Zion Medical Center, Haifa, Israel

Background: Morbidity and mortality in diabetic patients with Acute Coronary Syndrome (ACS) are dramatically higher compared to non-diabetic patients, particularly in patients with hypoglycemic events during hospitalization. Vildagliptin is an oral anti-diabetic drug of the new DPP-4 inhibitor class of drugs, it exhibits less frequent hypoglycemic events in Type 2 Diabetes Mellitus (T2DM) patients.

Objectives: To suggest a new paradigm of treatment in hospitalized diabetic ACS patients by adding Vildagliptin to conventional Insulin-only treatment.

Methods: 100 T2DM adult patients were enrolled when admitted to the ICCU with ACS diagnosis. Patients were divided into two groups in a randomized controlled manner. The control group received subcutaneous Insulin-only therapy while the study group received oral Vildagliptin in addition to the subcutaneous Insulin. Mean glucose values per hospitalization day, mean insulin values given for correction and hypoglycemic events (glucose

Results: 8 events of hypoglycemia occurred in the control group in comparison to none in the Vildagliptin treated group(t(45)=2.070, p<0.001(. No significant differences were found between the two groups in all background features. STEMI and NSTEMI diagnosed patients had significantly (p<0.05) higher number of hypoglycemic events compared to Unstable Angina diagnosed patients. No significant differences were found between the two groups in glucose level(t(88)=-0.739 ,p=0.462), and in given insulin units(t(87)=0.471,p=0.639).

Conclusions: In T2DM patients hospitalized for ACS, an addition of Vildagliptin to the routine subcutaneous insulin-only therapy significantly attenuated hypoglycemic events while maintaining identical mean glucose levels and insulin dosage compared to insulin-only therapy. Further studies are required to verify the promising results and to support it as a superior standard of treatment.

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