To the editor regarding article “Coadministration of DPP-4 inhibitor and insulin therapy does not further reduce the risk of cardiovascular events compared with DPP-4 inhibitor therapy in diabetic foot patients: a nationwide population-based study”

Excerpt

With great interest we read the article by Lin et al. [1] about the effect of insulin and DPP4i therapy on the development of major adverse cardiovascular events in patients with diabetic foot syndrome. In this retrospective study clinical data of 19,791 patients with confirmed diabetic foot syndrome were obtained from the Taiwan National Health Insurance program. The patient population was stratified in three groups: those receiving insulin therapy, those receiving DPP4i inhibitors and those who received the combined therapy with insulin and DPP4i inhibitors. These groups were then investigated for the occurrence of a major adverse cardiovascular event between 2007 and 2014. In cox regression analysis (adjusted for age, sex, hypertension, hyperlipidemia, nephropathy, retinopathy, peripheral neuropathy, antithrombotic therapy and the index date) the group which was treated only with DPP4i inhibitors had a significantly better cardiovascular outcome than those who received the combined therapy (HR 0.55). No significant difference was found between the combined group and the insulin group for MACE. Based on these findings the authors conclude: “there was no additional benefit in reducing the risk of cardiovascular events by adding insulin to DPP4i-based therapy for the patients with diabetic foot”. …