Summary: In a controlled study in poorly controlled type 2 diabetes on premixed insulin, adding vildagliptin reduced glycaemic variability and mean glucose and improved time in range and HbA1c over three months compared with adjusting insulin alone.
PICO Summary
| Element | Detail |
|---|---|
| Population | Adults with type 2 diabetes poorly controlled on premixed insulin, matched for age, duration, HbA1c, and BMI; China. |
| Intervention | Vildagliptin added to premixed insulin, with flash glucose monitoring at baseline and 3 months. |
| Comparison | Insulin dose adjustment alone, without vildagliptin. |
| Outcome | With vildagliptin, mean amplitude of glycaemic excursion fell 8.58→6.62 and mean glucose 10.7→8.82 mmol/L, time-above-range dropped (52.6→31.6%) and time-in-range rose (45.6→64.2%), with significant HbA1c and glycated-albumin reductions (all p<0.001 to 0.009 vs control). |
Vildagliptin added to premixed insulin
Matched controlled study · type 2 diabetes · 3 months
Adding vildagliptin to premixed insulin lowered glycaemic variability and mean glucose and improved time in range and HbA1c over three months versus adjusting insulin alone.
Expert Commentary
This is a sensible, clinically familiar result. Patients on premixed insulin often have brittle, swinging glucose profiles, and a DPP-4 inhibitor’s glucose-dependent action, enhancing insulin and suppressing glucagon mainly after meals, is well suited to smoothing those excursions without adding much hypoglycaemia risk. The data fit that expectation neatly: lower glycaemic variability, more time in range, and better HbA1c, the kind of combined improvement that flash monitoring captures well and that matters to how a patient actually feels day to day. My caveats are about study design and weight of evidence. This is a real-world, matched-comparison study rather than a large blinded randomised trial, so residual confounding between the groups cannot be excluded, the follow-up is only three months, and the effect sizes, while statistically clear, come from a modest single-centre cohort. Can I use this with my patients? Yes, comfortably and within existing practice. For someone on premixed insulin with troublesome variability who is not at target, adding a DPP-4 inhibitor such as vildagliptin is a reasonable, low-hypoglycaemia option to tighten control, and time-in-range is a fair way to judge the response.
References
Kong D, Shen Z, Jiang L, et al. The effects of vildagliptin on glycemic variability in patients with type 2 diabetes on premixed insulin therapy. Front Endocrinol (Lausanne). 2025;16:1508918. doi:10.3389/fendo.2025.1508918