Professional guidelines recommend insulin therapy for treatment of type 2 diabetes (T2D) in the hospital. However, oral antidiabetes drugs (OAD) are commonly used despite the lack of safety and efficacy data. We analyzed individual level data from non-critically ill patients with T2D admitted to three large healthcare systems between 2008-2018 (N=187,396). We conducted propensity score matching analyses to determine the relative efficacy and safety of OAD. Patients were treated with basal insulin (20%), sliding scale insulin alone (28%), basal insulin with OADs (23%), metformin (21%), sulfonylureas (11%), or DPP-4 inhibitors (4%). Less than 1% were treated with thiazolidinediones or SGLT2 inhibitors. Patients started on basal insulin had more comorbidities and had higher glucose levels on admission. After matching for age, BMI, Charlson Comorbidity Index, and admission blood glucose, exposure to OADs, with or without basal insulin, was associated with non-clinically meaningful differences in glycemic control compared to basal insulin use alone (183.1± 53.8 vs. 175.7± 53.9 vs. 180.3± 54.9, p<0.001). The use of OADs with SSI was associated with a lower incidence of hypoglycemia. However, among OADs without basal insulin, sulfonylureas were associated with the highest rate of hypoglycemia (30%), compared to Metformin (16%), DPP-4i (15%) or TZDs (14%), p<0.001. There were no differences in lactic acidosis between groups. Patients treated with basal insulin had a higher mortality (2%) compared to basal insulin+ OAD (0.3%) or OAD alone (0.6%).

In summary, the use of OADs with or without basal insulin is associated with acceptable glycemic control compared to insulin therapy. Basal insulin use and the use of sulfonylureas is associated with a high incidence of hypoglycemia.


F.J. Pasquel: Advisory Panel; Self; AstraZeneca, Eli Lilly and Company. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp. Research Support; Self; Dexcom, Inc., Merck Sharp & Dohme Corp., National Institutes of Health. M.F. Magee: Consultant; Self; Mytonomy. Employee; Spouse/Partner; U.S. Food and Drug Administration. Research Support; Self; AstraZeneca, Eli Lilly and Company, National Institute of Diabetes and Digestive and Kidney Diseases. Speaker’s Bureau; Self; American Diabetes Association, Pri-Med LLC. Other Relationship; Self; Endocrine Society. I. Hochberg: None. C. Fortin: None. A. Migdal: None. S. Cardona: None. M. Fayfman: None. Y. Guo: None. L. Peng: None. G.E. Umpierrez: None.


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