2025 Southeastern Residency Conference

Title:
Evaluation of SGLT2 Inhibitor Effects on Glycemic Management in Hospitalized Non-Critically Ill Patients 
 
Authors: 
EJ Marineau, PharmD
Dennis Dubovetsky, PharmD
 
Background:
The American Association of Clinical Endocrinology (AACE) and American Diabetes Association (ADA) guidelines recommend the use of sodium-glucose co-transporter-2 inhibitors (SGLT2i) in patients with type 2 diabetes mellitus (T2DM) who either have established or are high-risk for atherosclerotic cardiovascular disease, heart failure (HF), or chronic kidney disease. ADA endorses use of SGLT2i in T2DM patients hospitalized with HF, while AACE and Endocrine society guidelines provide no guidance on SGLT2i role in hospitalized patient population. Only a handful of studies focused on evaluation and reported glycemic management outcomes and safety in hospitalized patients with T2DM receiving SGLT2i. Due to this increased inpatient use, additional data on safety and efficacy for glycemic management is warranted. The objective of this study was to assess the safety and efficacy of SGLT2i in the management of T2DM in non-critically ill hospitalized patients.
 
Methods:
This was a single-center, retrospective chart review conducted at AdventHealth Orlando. Patients were enrolled if they were at least 18 years of age and had an established history of T2DM.  Intervention group consisted of patients who received a SGLT2i plus multimodal insulin and compared to patients who received multimodal insulin alone. Primary objective evaluated difference in median blood glucoses.  Secondary objectives evaluated difference: percentage of blood glucose readings within target range (100 to 180 mg/dl), total insulin dose (units), 90-day all-cause readmission rate, inpatient mortality, rate of acute kidney injury, length of stay (days), percentage of patients with hypoglycemic events (less than 70 mg/dl), and rate of new onset ketoacidosis.
 
Results: 
A total of 150 patients met the inclusion criteria and were evenly distributed into each arm. There was a significant difference in the primary outcome of median blood glucose in favor of the SGLT2i arm (165 mg/dL) compared to the insulin alone arm (180 mg/dL, p<0.001). Patients in the SGLT2i arm received lower median total daily dose of insulin (15 versus 16 units, p=0.006). SGLT2i arm was associated with lower median number of 90-day readmissions (28 versus 48 p=0.005). There was no difference between the groups with respect to remaining safety secondary outcomes of inpatient mortality, length of stay, acute kidney injury, rates of hypoglycemic events and ketoacidosis (p=NS).

Conclusions:
In acutely ill hospitalized patients with T2DM treatment with SGLT2i in addition to standard care (multimodal insulin) was associated with overall lower blood glucose values, lower insulin requirements, and a lower rate of 90-day readmissions when compared to insulin only strategy. SGLT2i exposure was not associated with significant difference in other safety outcomes. Further studies are warranted to characterize safety and efficacy profile of SGLT2i as an option for inpatient glycemic management.