Role of incretin-based therapy in hospitalized patients with type 2 diabetes

Abstract

Evidence about the treatment of hospitalized type 2 diabetes patients with incretin-based therapy has emerged in the past 15 years. Based on this evidence, dipeptidyl peptidase-4 inhibitors should be considered for hospitalized patients with type 2 diabetes and an algorithm for this is proposed. In relation to use of glucagon-like peptide-1 and glucagon-like peptide-1 receptor agonist, further research is required to help define their role in the inpatient setting.

© 2019 The Author. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

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Figure 1

Algorithm proposed for the management of hyperglycemia in hospitalized patients with type 2 diabetes based of evidence. 1The choice of scheme is based on individual characteristics of patients: (i) use basal–bolus regimen considering the following: mean daily glucose >250 mg/dL, glycated hemoglobin ≥9%, previous insulin therapy at a daily dose ≥0.4 U/kg; (ii) use basal‐plus regimen or dipeptidyl peptidase‐4 (DPP‐4) inhibitor as follows: mean daily glucose between 180 and 250 mg/dL, glycated hemoglobin <9%, fasting C‐peptide index at hospital admission ≥1.103 ng/mL, no previous insulin therapy or at a daily dose <0.4 U/kg, fasting patients or with low food intake, elderly patients or with renal failure. 2In patients aged ≥70 years and those with estimated glomerular filtration rate (eGFR) <30 mL/min per 1.73 m2, reduce the dose to 0.15 U/kg. 3Use alone or in combination with the basal‐plus regimen. 4For patients with eGFR >50 mL/min per 1.73 m2, use the dose of 100 mg/day; if eGFR is between 30 and 50 mL/min per 1.73 m2, use 50 mg/day; and if eGFR is <30 mL/min per 1.73 m2, use 25 mg/day. 5Use 2.5 mg/day in patients with eGFR <50 mL/min per 1.73 m2 or if using strong CYP3A4/5 inhibitors.