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

Pasquel, Francisco J.; Fayfman, Maya; Umpiérrez, Guillermo E.

doi:10.1007/s11892-019-1184-8

Cited by 48 publications

(49 citation statements)

References 86 publications

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“… 11 27 28 Insulin therapy is commonly used in the hospital setting, and although US professional associations recommend insulin as the therapy of choice in the hospital, the use of non-insulin agents is not uncommon. 29 Opinion-based recommendations suggest non-insulin agents should be implemented carefully in patients with diabetes and COVID-19. 11 30 31 Standardized insulin regimens with multiple-dose injections are complex, require frequent point-of-care (POC) glucose testing, and are associated with iatrogenic hypoglycemia.…”

Section: Introductionmentioning

confidence: 99%

“… 11 30 31 Standardized insulin regimens with multiple-dose injections are complex, require frequent point-of-care (POC) glucose testing, and are associated with iatrogenic hypoglycemia. 29 In the intensive care unit, insulin therapy is even less convenient, with patients requiring hourly POC testing when treated with intravenous continuous insulin infusion. 20 Therefore, to simplify therapy, preserve PPE, and limit bedside interactions, academic centers and hospitals around the nation are adapting their inpatient diabetes care strategies in response to COVID-19.…”

Section: Introductionmentioning

confidence: 99%

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Preparedness cycle to address transitions in diabetes care during the COVID-19 pandemic and future outbreaks

Gujral

Johnson

et al. 2020

BMJ Open Diab Res Care

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The COVID-19 pandemic is considered a mass casualty incident of the most severe nature leading to unearthed uncertainties around management, prevention, and care. As of July 2020, more than twelve million people have tested positive for COVID-19 globally and more than 500 000 people have died. Patients with diabetes are among the most severely affected during this pandemic. Healthcare systems have made emergent changes to adapt to this public health crisis, including changes in diabetes care. Adaptations in diabetes care in the hospital (ie, changes in treatment protocols according to clinical status, diabetes technology implementation) and outpatient setting (telemedicine, mail delivery, patient education, risk stratification, monitoring) have been improvised to address this challenge. We describe how to respond to the current public health crisis focused on diabetes care in the USA. We present strategies to address and evaluate transitions in diabetes care occurring in the immediate short-term (ie, response and mitigation), as well as phases to adapt and enhance diabetes care during the months and years to come while also preparing for future pandemics (ie, recovery, surveillance, and preparedness). Implementing multidimensional frameworks may help identify gaps in care, alleviate initial demands, mitigate potential harms, and improve implementation strategies and outcomes in the future.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preparedness cycle to address transitions in diabetes care during the COVID-19 pandemic and future outbreaks

Gujral

Johnson

et al. 2020

BMJ Open Diab Res Care

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“…Pasquel et al . [16] have proposed a practical algorithm for the management of inpatient hyperglycaemia with oral antidiabetes agents and insulin, based on the results of available RCTs. According to this algorithm, stable patients can be managed with a DPP‐4 inhibitor, provided that they present mild hyperglycaemia (< 11.1 mmol/l) and are insulin‐naïve.…”

Section: Discussionmentioning

confidence: 99%

Oral antidiabetes agents for the management of inpatient hyperglycaemia: so far, yet so close

et al. 2020

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Background Hyperglycaemia is an ongoing challenge in hospital settings and is associated with poor outcomes. Current recommendations for the management of inpatient hyperglycaemia suggest insulin as the main glucose-lowering treatment choice and limit the administration of oral antidiabetes agents to a small proportion of cases because of safety concerns. Aim To present and critically appraise the available evidence on the use of oral antidiabetes agents in the hospital setting and the risk-benefit balance of such an approach in the era of cardiovascular outcomes trials. Methods PubMed, Embase and Google Scholar databases were searched to identify relevant published work. Available evidence on the efficacy and the safety profile of oral agents in the context of their use in hospitalized individuals are summarized and discussed in this narrative review. Results There is no robust evidence to suggest the use of metformin, thiazolidinediones, sulfonylureas and sodium-glucose co-transporter-2 inhibitors in the hospital setting, although some of their effects on acute outcomes deserve further evaluation in future studies. However, the use of dipeptidyl peptidase-4 inhibitors in inpatients with type 2 diabetes is supported by a few, well-designed, randomized controlled trials. These trials have demonstrated good safety and tolerability profiles, comparable to insulin glucose-lowering efficacy, and a reduction in insulin dose when dipeptidyl peptidase-4 inhibitors are co-administered with insulin, in individuals with mild to moderate hyperglycaemia and a stable clinical condition. Conclusion The administration of dipeptidyl peptidase-4 inhibitors to specific groups of inpatients might be a safe and effective alternative to insulin.

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“…13 Experts have suggested that we need to revise guidelines to allow more usage of non-insulin anti-diabetic medications for hospitalized patients. 14 Given the dire situation presented by the COVID-19 global pandemic, we should accelerate this dialog to assess the positive impact that may be provided by utilization of agents requiring less monitoring, fewer healthcare provider contacts, and a lower risk of hypoglycemia. Health care providers and the community as a whole have entered uncharted territory during the COVID-19 pandemic, which has resulted in the development of innovations in delivering medical care while maintaining maximum patient and provider safety, which is a critical and challenging task.…”

Section: Inpatient Diabetes and Hyperglycemiamentioning

confidence: 99%

Inpatient Diabetes and Hyperglycemia Management Protocol in the COVID-19 Era

Aljehani

Funke

Hermayer

2020

The American Journal of the Medical Sciences

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

Cited by 48 publications

References 86 publications

Preparedness cycle to address transitions in diabetes care during the COVID-19 pandemic and future outbreaks

Preparedness cycle to address transitions in diabetes care during the COVID-19 pandemic and future outbreaks

Oral antidiabetes agents for the management of inpatient hyperglycaemia: so far, yet so close

Inpatient Diabetes and Hyperglycemia Management Protocol in the COVID-19 Era

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