Non-insulin therapy in diabetic inpatients: SGLT2- inhibitors and incretins for the care of hospitalized patients

Abstract

Hyperglycemia is a common event in hospitalized patients and it is an independent marker of morbidity and mortality in both critically and non-critically ill patients. Maintaining a good glycemic control in the hospital setting improves patient outcomes and reduce costs of hospitalization. The insulin therapy has so far been the main hypoglycemic treatment used in the hospital setting, but it requires trained healthcare personnel and can determine a non-negligible risk of hypoglycemia. In the recent years the use of hypoglycemic drugs with innovative mechanisms of action, such as glycosurics (the sodium-glucose co-transporter 2 inhibitors, SGLT2-i) and incretinomimetics (the agonists of the glucagon - like peptide - 1, GLP-1 RA, and dipeptidyl-peptidase IV inhibitors, DPP4-I) has increased in diabetic outpatient care. Nowadays the use of these drugs is recommended by the most recent guidelines on the management of diabetes for the notable advantages in terms of cardiovascular safety and efficacy. However, there are still few data available on their use in inpatients that could support their adoption in routine clinical practice. A wider consumption of these drugs could notably reduce the need for insulin therapy in hospital, even if it is important to consider possible side effects and availability in the hospital formulary. The purpose of this review is to analyze data from the international literature on possible indications and limitations of glycosurics and incretinomimetics in the hospital setting, particularly regard safety and tolerability in some specific contexts. We can conclude that it is reasonable to propose the use of glycosurics and incretinomimetics in non-critical patients with specific comorbidities DPP4-I in elderly and frail patients or with renal insufficiency; GLP1-RA in patients in secondary prevention or with high cardiovascular risk; SGLT2-i in patients with heart failure. KEY WORDS diabetes; inpatient; therapy; incretinomimetics; glycosurics.