A Real-World Study of Oral Antihyperglycemic Agents as Compared With Basal Insulin in Hospitalized Patients With Type 2 Diabetes.

OBJECTIVE

Oral antihyperglycemic drugs (OADs) are commonly used in the hospital despite limited safety and efficacy data.

METHODS

We pooled data from 3 health care systems in the United States and Israel from 2010 to 2019 (n = 79 047) of hospitalized patients with type 2 diabetes. Treatment with OADs was compared with insulin-based therapy ("basal") and combined OAD and basal insulin ("OAD + basal"). The primary outcome was inpatient target glycemia defined as a mean blood glucose (BG) level of 80 to 180 mg/dL and no hypoglycemia (<70 mg/dL). We conducted inverse probability weighting adjusting for age, sex, admission BG, creatinine, specialty type (medicine vs surgery), and Charlson Comorbidity scores.

RESULTS

People treated with basal insulin had higher admission BG and comorbidities than those in the other 2 groups. Compared with basal, people treated with OAD were more likely to have target glycemia (odds ratio [OR]: 2.07; 95% confidence interval [CI]: 1.85, 2.31) and lower odds of hypoglycemia (OR: 0.54; 95% CI: 0.46, 0.62), whereas OAD + basal showed no difference in glycemia (OR: 0.99; 95% CI: 0.95, 1.04). Metformin monotherapy was not associated with higher risk of lactic acidosis. Patients treated with sulfonylureas had higher rates of hypoglycemia. Mortality was lower among those treated with OADs (OR: 0.16; 95% CI: 0.11, 0.24) and OAD + basal (OR: 0.34; 95% CI: 0.23, 0.49) as compared with basal.

CONCLUSION

The use of OADs in the hospital appeared to be safe and effective for management of hyperglycemia among patients with type 2 diabetes and a lower burden of comorbidities.