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Use of Non-insulin Agents for Hyperglycemia Management in Hospitalized Patients

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Diabetes Management in Hospitalized Patients

Part of the book series: Contemporary Endocrinology ((COE))

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Abstract

Hyperglycemia in hospitalized patients predicts increased morbidity and mortality. Basal-bolus insulin represents the primary recommended therapy for inpatient glucose control. Insulin, however, is expensive and can cause hypoglycemia. Newer data demonstrating the safety and efficacy of agents with low hypoglycemia risk are changing the current paradigm. Randomized controlled trials show that DPP-4 inhibitors can safely and effectively treat mild-to-moderate hyperglycemia. Studies on GLP-1 receptor agonists also look encouraging but remain insufficient to definitively recommend use and show increased gastrointestinal side effects. SGLT-2 inhibitors may aid patients with congestive heart failure but pose a risk of ketoacidosis. While metformin appears safe for patients without risk of lactic acidosis, no randomized controlled trials exist to support its use. Sulfonylureas pose significant hypoglycemia risk and should not play a role in inpatient glycemic control. Minimal data address the use of thiazolidinediones, meglitinides, or alpha-glucosidase inhibitors, and each causes side effects that limit inpatient utility.

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Authors and Affiliations

  1. Division of Endocrinology, Diabetes and Metabolism, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA

    Yael T. Harris

  2. New York Health + Hospitals-Queens, Jamaica, NY, USA

    David M. Reich

  3. Division of Hospital Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA

    Xiao Qing Li

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Correspondence to Yael T. Harris .

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  1. Division of Endocrinology, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY, USA

    Rifka C. Schulman-Rosenbaum

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Harris, Y.T., Reich, D.M., Li, X.Q. (2023). Use of Non-insulin Agents for Hyperglycemia Management in Hospitalized Patients. In: Schulman-Rosenbaum, R.C. (eds) Diabetes Management in Hospitalized Patients. Contemporary Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-031-44648-1_6

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