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Improving IV Insulin Administration in a Community Hospital

Improving IV Insulin Administration in a Community Hospital

Published on: June 11, 2012

A Real-World Study of Oral Antihyperglycemic Agents as Compared With Basal Insulin in Hospitalized Patients With Type

Maya Fayfman¹, Irit Hochberg², Michelle Magee³

¹Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Grady Memorial Hospital, Atlanta, Georgia.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

|July 10, 2025

Abstract

Objective:

Oral antihyperglycemic drugs (OADs) are commonly used in the hospital despite limited safety and efficacy data.

Methods:

We pooled data from 3 health care systems in the United States and Israel from 2010 to 2019 (n = 79 047) of hospitalized patients with type 2 diabetes. Treatment with OADs was compared with insulin-based therapy ("basal") and combined OAD and basal insulin ("OAD + basal"). The primary outcome was inpatient target glycemia defined as a mean blood glucose (BG) level of 80 to 180 mg/dL and no hypoglycemia (<70 mg/dL). We conducted inverse probability weighting adjusting for age, sex, admission BG, creatinine, specialty type (medicine vs surgery), and Charlson Comorbidity scores.

Results:

People treated with basal insulin had higher admission BG and comorbidities than those in the other 2 groups. Compared with basal, people treated with OAD were more likely to have target glycemia (odds ratio [OR]: 2.07; 95% confidence interval [CI]: 1.85, 2.31) and lower odds of hypoglycemia (OR: 0.54; 95% CI: 0.46, 0.62), whereas OAD + basal showed no difference in glycemia (OR: 0.99; 95% CI: 0.95, 1.04). Metformin monotherapy was not associated with higher risk of lactic acidosis. Patients treated with sulfonylureas had higher rates of hypoglycemia. Mortality was lower among those treated with OADs (OR: 0.16; 95% CI: 0.11, 0.24) and OAD + basal (OR: 0.34; 95% CI: 0.23, 0.49) as compared with basal.

Conclusion:

The use of OADs in the hospital appeared to be safe and effective for management of hyperglycemia among patients with type 2 diabetes and a lower burden of comorbidities.

Keywords:

hospital diabetes management hyperglycemia oral antidiabetic drugs type 2 diabetes

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