Colombia: Inpatient management of type 2 diabetes patients in the general ward with GLP1Ra and DPP4i is equally safe and effective compared to insulin management, according to a recent review. The study was published in the journal Diabetes Research and Clinical Practice on August 02, 2022.
Insulin alone is recommended currently for in-hospital management of diabetes, but growing evidence suggests that new oral or injectable agents may be as safe and effective. María Juliana Soto-Chávez, Pontificia Universidad Javeriana. Bogotá, Colombia, and colleagues, therefore, aimed to evaluate the safety and effectiveness of new oral and injectable antidiabetic drugs versus the usual insulin management, for the management of patients hospitalized in the general ward with type 2 diabetes mellitus. They synthesized and critically evaluate the evidence available in randomized and nonrandomized studies.

For this purpose, the researchers conducted a systematic review and meta-analysis with evidence from randomized (RCT) and non-randomized (NRS) studies in online databases up to February 10, 2022. It included studies that included hospitalized type 2 diabetes patients, comparing dipeptidyl peptidase 4 inhibitors (DPP4i), sodium-glucose co-transporter 2 inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonist (GLP1Ra) with insulin alone for glycemic control and safety outcomes. A total of 7 RCTs and 3 NRTs were included.
Based on the study, the researchers found the following:
There were no differences in mean blood glucose, measurements within range, or rate of hypoglycemia between DPP4i and insulin.
Lower mean glucose for GLP1Ra plus insulin subgroup (-16.36 mg/dL) was found with a lower incidence of hypoglycemia <70 mg/dL with GLP1Ra (RR 0.31).
SGLT2i data was limited. The rate of adverse events was similar between treatments.
The researchers wrote, "in-hospital management with incretin-based therapies (DPP4i, GLP1Ra) and SGLT2i with or without sliding scale insulin does not present differences with respect to insulin management in the usual schemes (BB, BP) with regards to safety and efficacy, with a benefit in mean glucose and hypoglycemia incidence with GLP1Ra."
"We however emphasize that there is still a scarcity of evidence supporting these findings," they conclude. "Our study opens the way for large clinical trials that may change the paradigm of insulin use as the cornerstone of diabetes treatment for in-hospital settings in non-critical wards."
Reference:
Juliana Soto-Chávez M, Mauricio Muñoz-Velandia O, Pablo Álzate Granados J, Ernesto Lombo C, Cristina Henao Carrillo D, María Gómez Medina A. Effectiveness and safety of new oral and injectable agents for in-hospital management of type 2 diabetes in general wards: systematic review and meta-analysis. Diabetes Res Clin Pract. 2022 Aug 2:110019. doi: 10.1016/j.diabres.2022.110019. Epub ahead of print. PMID: 35931222.