The Efficacy and Safety of Co-Administration of Sitagliptin With Metformin in Patients With Type 2 Diabetes at Hospital Discharge

Gianchandani, Roma; Pasquel, Francisco J.; Rubin, Daniel J.; Dungan, Kathleen; Vellanki, Priyathama; Wang, Heqiong; Anzola, Isabel; Gomez, Patricia; Hodish, Israel; Lathkar‐Pradhan, Sangeeta; Iyengar, Jennifer J.; Umpiérrez, Guillermo E.

doi:10.4158/ep-2018-0036

Cited by 14 publications

(23 citation statements)

References 20 publications

(28 reference statements)

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“…Several observational and randomized controlled trials have shown that this is an effective regimen in achieving glycemic control and in reducing hospital complications (9,15). However, the requirement of multiple insulin injections and associated risk of hypoglycemia (16,17) has triggered the study of alternative approaches for the management of patients with diabetes in the hospital (18,19) and after discharge (20).…”

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confidence: 99%

A Randomized Controlled Trial on the Safety and Efficacy of Exenatide Therapy for the Inpatient Management of General Medicine and Surgery Patients With Type 2 Diabetes

et al. 2019

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OBJECTIVEThis multicenter, open-label, randomized trial examined the safety and efficacy of exenatide alone or in combination with basal insulin in non-critically ill patients with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODSA total of 150 patients with blood glucose (BG) between 140 and 400 mg/dL, treated at home with diet, oral agents, or insulin at a total daily dose <0.5 units/kg, were randomized to exenatide alone (5 mg twice daily), exenatide plus basal insulin, or a basal-bolus insulin regimen. The primary end point was difference in mean daily BG concentration among groups. RESULTSMean daily BG was similar between patients treated with exenatide plus basal and a basal-bolus regimen (154 6 39 vs. 166 6 40 mg/dL, P = 0.31), and exenatide plus basal resulted in lower daily BG than did exenatide alone (177 6 41 mg/dL, P = 0.02). Exenatide plus basal resulted in a higher proportion of BG levels in target range between 70 and 180 mg/dL compared with exenatide and basal-bolus (78% vs. 62% vs. 63%, respectively, P = 0.023). More patients in the exenatide and exenatide plus basal groups experienced nausea or vomiting than in the basal-bolus group (10% vs. 11% vs. 2%, P = 0.17), with three patients (6%) discontinued exenatide owing to adverse events. There were no differences in hypoglycemia <54 mg/dL (2% vs. 0% vs. 4%, P = 0.77) or length of stay (5 vs. 4 vs. 4 days, P = 0.23) among basal plus exenatide, exenatide, and basal-bolus groups. CONCLUSIONSThe results of this pilot study indicate that exenatide alone or in combination with basal insulin is safe and effective for the management of hospitalized general medical and surgical patients with T2D.

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A Randomized Controlled Trial on the Safety and Efficacy of Exenatide Therapy for the Inpatient Management of General Medicine and Surgery Patients With Type 2 Diabetes

et al. 2019

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“…This probably reflects a need to redefine these conditions, in order to minimize unnecessary avoidance of the drug [15]. Even if metformin administration is stopped during admission, it can be safely restarted in most cases a few days prior to discharge, thus facilitating dose adjustment of basal insulin and the building of a discharge regimen [23]. Still, there are significant barriers to its administration to inpatients, including the risk of gastrointestinal adverse effects and lactic acidosis.…”

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confidence: 99%

“…Gianchandani et al . [23] conducted a multicentre, prospective, non‐randomized, open‐label clinical trial to evaluate the safety and efficacy of combined therapy with metformin and sitagliptin, either with or without basal insulin, in people with type 2 diabetes discharged from general medicine and surgical wards. According to admission HbA 1c concentrations, 253 participants were randomized to three arms: discharged on sitagliptin and metformin [HbA 1c < 53 mmol/mol (7%)]; discharged on sitagliptin, metformin and glargine U100 insulin at 50% of the hospital daily dose [HbA 1c 53–75 mmol/mol (7–9%)]; and discharged on sitagliptin, metformin and glargine U100 insulin at 80% of the hospital daily dose [HbA 1c > 75 mmol/mol (9%)].…”

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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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“…An HbA1c‐based diabetes discharge treatment algorithm suggested that resuming outpatient treatment if HbA1c was below 7%, adding basal insulin at 50% to 80% of the dose used in hospital for HbA1c between 7% and 9%, and either basal‐bolus or resumption of outpatient treatment along with basal insulin glargine for HbA1c exceeding 9%, although in a study of this approach nearly half of those discharged on basal‐bolus insulin developed hypoglycemia . The use of a dipeptidyl peptidase (DPP)‐4 inhibitor with a similar regimen appeared to lead to less hypoglycemia . Avoiding rehospitalization is crucial.…”

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“…19 The use of a dipeptidyl peptidase (DPP)-4 inhibitor with a similar regimen appeared to lead to less hypoglycemia. 20 Avoiding rehospitalization is crucial. Rubin observed that as many as one-fifth of patients are readmitted within 30 days of discharge, at a total cost of US $123 billion/year.…”

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Ada2019

Bloomgarden

2019

Journal of Diabetes

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The Efficacy and Safety of Co-Administration of Sitagliptin With Metformin in Patients With Type 2 Diabetes at Hospital Discharge

Abstract: BG = blood glucose; DPP-4 = dipeptidyl peptidase-4; eGFR = estimated glomerular filtration rate; HbA1c = hemoglobin A1c; T2D = type 2 diabetes.

Cited by 14 publications

References 20 publications

A Randomized Controlled Trial on the Safety and Efficacy of Exenatide Therapy for the Inpatient Management of General Medicine and Surgery Patients With Type 2 Diabetes

A Randomized Controlled Trial on the Safety and Efficacy of Exenatide Therapy for the Inpatient Management of General Medicine and Surgery Patients With Type 2 Diabetes

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

Ada2019

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