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Current Diabetes Reports
Published in: Current Diabetes Reports 9/2019

01-09-2019 | Sitagliptin | Debate

Debate on Insulin vs Non-insulin Use in the Hospital Setting—Is It Time to Revise the Guidelines for the Management of Inpatient Diabetes?

Authors: Francisco J. Pasquel, Maya Fayfman, Guillermo E. Umpierrez

Published in: Current Diabetes Reports | Issue 9/2019

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Abstract

Purpose of Review

Hyperglycemia contributes to a significant increase in morbidity, mortality, and healthcare costs in the hospital. Professional associations recommend insulin as the mainstay of diabetes therapy in the inpatient setting. The standard of care basal–bolus insulin regimen is a labor-intensive approach associated with a significant risk of iatrogenic hypoglycemia. This review summarizes recent evidence from observational studies and clinical trials suggesting that not all patients require treatment with complex insulin regimens.

Recent Findings

Evidence from clinical trials shows that incretin-based agents are effective in appropriately selected hospitalized patients and may be a safe alternative to complicated insulin regimens. Observational studies also show that older agents (i.e., metformin and sulfonylureas) are commonly used in the hospital, but there are few carefully designed studies addressing their efficacy.

Summary

Therapy with dipeptidyl peptidase-4 (DPP-4) inhibitors, alone or in combination with basal insulin, may effectively control glucose levels in patients with mild to moderate hyperglycemia. Further studies with glucagon-like peptide-1 (GLP-1) receptor analogs and older oral agents are needed to confirm their safety in the hospital.
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Metadata
Title
Debate on Insulin vs Non-insulin Use in the Hospital Setting—Is It Time to Revise the Guidelines for the Management of Inpatient Diabetes?
Authors
Francisco J. Pasquel
Maya Fayfman
Guillermo E. Umpierrez
Publication date
01-09-2019
Publisher
Springer US
Published in
Current Diabetes Reports / Issue 9/2019
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI
https://doi.org/10.1007/s11892-019-1184-8

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