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OBJECTIVEThis study investigated the safety and efficacy of sitagliptin (Januvia) for the inpatient management of type 2 diabetes (T2D) in general medicine and surgery patients.RESEARCH DESIGN AND METHODSIn this pilot, multicenter, open-label, randomized study, patients (n = 90) with a known history of T2D treated with diet, oral antidiabetic agents, or low total daily dose of insulin (≤0.4 units/kg/day) were randomized to receive sitagliptin alone or in combination with glargine insulin (glargine) or to a basal bolus insulin regimen (glargine and lispro) plus supplemental (correction) doses of lispro. Major study outcomes included differences in daily blood glucose (BG), frequency of treatment failures (defined as three or more consecutive BG >240 mg/dL or a mean daily BG >240 mg/dL), and hypoglycemia between groups.RESULTSGlycemic control improved similarly in all treatment groups. There were no differences in the mean daily BG after the 1st day of treatment (P = 0.23), number of readings within a BG target of 70 and 140 mg/dL (P = 0.53), number of BG readings >200 mg/dL (P = 0.23), and number of treatment failures (P > 0.99). The total daily insulin dose and number of insulin injections were significantly less in the sitagliptin groups compared with the basal bolus group (both P < 0.001). There were no differences in length of hospital stay (P = 0.78) or in the number of hypoglycemic events between groups (P = 0.86).CONCLUSIONSResults of this pilot indicate that treatment with sitagliptin alone or in combination with basal insulin is safe and effective for the management of hyperglycemia in general medicine and surgery patients with T2D.

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Disclosure: Nothing to report. BACKGROUND:The optimal approach to managing hyperglycemia in noncritically ill hospital patients is unclear. OBJECTIVE: To investigate the effects of targeted quality improvement interventions on insulin prescribing and glycemic

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HOSPITAL MEDICINE CLINICS CHECKLIST1. Acute exacerbations of chronic obstructive pulmonary disease (COPD) are common in the course of chronic COPD, and are associated with substantial morbidity. 2. There are numerous guidelines, but literature suggests that there is substantial variation in care in patients with acute exacerbations of COPD. 3. Key components of acute therapy for most patients include oral steroids, antibiotics, nebulizers, oxygen, and early consideration of noninvasive ventilation. 4. Adjuvant components of care include venous thromboembolism prophylaxis, appropriate immunizations, counseling for smoking cessation, and consideration of pulmonary rehabilitation. DEFINITIONS AND BURDEN OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND EXACERBATIONSHow is chronic obstructive pulmonary disease defined and diagnosed?Chronic obstructive pulmonary disease (COPD) is an acquired and progressive pulmonary disorder. The principal physiologic lesion is airflow limitation, demonstrated on pulmonary function testing. Pathophysiologically, COPD is marked by evidence of chronic airway inflammation, loss of airway elasticity, and destruction of the alveoli. COPD develops over years of exposure to noxious substances. At least 80% of the overall risk is considered attributable to smoking and exposure to smoking. Air pollution and other environmental agents may cause or contribute to COPD, in addition to unusual inherited disorders such as a1-antitrypsin deficiency.