Insulin therapy is the preferred treatment for glycemic control in the hospital. Oral antidiabetes drugs (OAD) are commonly used despite the lack of safety and efficacy data. We analyzed individual patient-data of non-critically ill patients with T2D admitted to a teaching medical institution between 2008 - 2018 to determine the relative efficacy and safety of OAD. We did logistic regression analysis adjusting for relevant covariates. A total of 10,205 patients were included in the analysis, 970 patients (9.5%) were treated with OAD, 691 (6.8%) with OAD plus basal insulin, and 8,544 (83.7%) with basal insulin. Patients treated with OAD had lower admission BG and HbA1c and had less comorbidities compared to those receiving basal insulin. Hypoglycemia was less common with metformin (2.4%) and DPP-4i (0.0%) compared to sulfonylureas (13%) or insulin therapy (13%). After adjusting for age, gender, BMI, race, hospital setting, Charlson score, and admission creatinine, treatment with OADs was associated with better BG control and lower odds of complications compared to insulin use (Figure).

Conclusion: The use of OAD in the hospital appears to be safe and effective and is not associated with higher odds of complications, with the exception of sulfonylurea use that is associated with a high rate of hypoglycemia. Residual confounding due to selection assignment to basal insulin therapy to sicker patients is probable.


F.J. Pasquel: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck & Co., Inc. M.F. Magee: Consultant; Self; Mytonomy. Research Support; Self; Lilly Diabetes, Mytonomy, Sanofi. Speaker's Bureau; Self; PRIMED. I. Hochberg: None. R.B. Hawthorne: None. L. Peng: None. G.E. Umpierrez: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc. Research Support; Self; AstraZeneca, Merck & Co., Inc., Novo Nordisk Inc., Sanofi US.

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