Type 2 diabetes

SGLT2 inhibitors vs DPP4 inhibitors compared in inpatients

SGLT2 inhibitors achieve similar glycemic control compared to DPP4 inhibitors in hospitalised patients, without an increase in overall complications, mortality or the risk of hypoglycaemia.

A retrospective observational study of the EMR at the Austin Hospital comprised more than 10,000 inpatients with type 2 diabetes aged ≥ 54 years who received at least one oral hypoglycaemic agent or insulin during their admission between January 2015 and December 2019.

The study, published in the Journal of Diabetes and its Complications, found SGLT2i use was associated with no significant difference in the percentage of glucose measurements < 4 mmol/L, in range between 4 and 10 mmol/L, or > 10 mmol/L when compared with DPP4i use.

As well, there were no significant differences in length of stay, in-hospital mortality, most complications or acute kidney injury.

“We also found that ketone levels, when measured in the first 7 days of hospital stay, were not higher in the SGLT2i group and the percentage of bicarbonate measurements within range was similar,” the study said.

The investigators, including Associate Professor Elif Ekinci, said the major concern with SGLT2i in hospitalised patients was euglycaemic DKA, leading to guidelines discouraging their use especially in surgical patients.

However the study found DPP4i were not the only oral hypoglycaemic agents safe enough for in-patient use.

“These findings logically imply that SGLT2i may be an alternative to DPP4i’s and traditional insulin regimens, in patients who were receiving these agents prior to admission.”

“That is, these findings imply that SGLT2i may be continued during hospital admission in some patients.”

“These hypothesis-generating findings support further investigation of SGLT2i use in the inpatient setting and the need for randomised controlled trials in hospitalised patients.”

The study noted that most patients who received an SGLT2i in hospital were also receiving them in the community prior to admission.

“Notably, more than half of SGLT2i users who had this agent ceased during admission, were discharged without it.”

“This is particularly important given an increasing body of evidence demonstrating the long-term cardiorenal protective effects of SGLT2i.”


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