Division of Endocrinology and Metabolism and Diabetes Centre, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
Department of Diabetes, King's College Hospital, London, UK.
Diabet Med. 2020 Sep;37(9):1418-1426. doi: 10.1111/dme.14329. Epub 2020 Jun 7.
Hyperglycaemia is an ongoing challenge in hospital settings and is associated with poor outcomes. Current recommendations for the management of inpatient hyperglycaemia suggest insulin as the main glucose-lowering treatment choice and limit the administration of oral antidiabetes agents to a small proportion of cases because of safety concerns.
To present and critically appraise the available evidence on the use of oral antidiabetes agents in the hospital setting and the risk-benefit balance of such an approach in the era of cardiovascular outcomes trials.
PubMed, Embase and Google Scholar databases were searched to identify relevant published work. Available evidence on the efficacy and the safety profile of oral agents in the context of their use in hospitalized individuals are summarized and discussed in this narrative review.
There is no robust evidence to suggest the use of metformin, thiazolidinediones, sulfonylureas and sodium-glucose co-transporter-2 inhibitors in the hospital setting, although some of their effects on acute outcomes deserve further evaluation in future studies. However, the use of dipeptidyl peptidase-4 inhibitors in inpatients with type 2 diabetes is supported by a few, well-designed, randomized controlled trials. These trials have demonstrated good safety and tolerability profiles, comparable to insulin glucose-lowering efficacy, and a reduction in insulin dose when dipeptidyl peptidase-4 inhibitors are co-administered with insulin, in individuals with mild to moderate hyperglycaemia and a stable clinical condition.
The administration of dipeptidyl peptidase-4 inhibitors to specific groups of inpatients might be a safe and effective alternative to insulin.
高血糖是医院环境中的一个持续存在的挑战，与不良结局相关。目前，针对住院患者高血糖的管理建议，将胰岛素作为主要的降血糖治疗选择，并由于安全性考虑，将口服抗糖尿病药物的使用限制在少数情况下。
介绍并批判性评估在心血管结局试验时代，口服抗糖尿病药物在医院环境中的使用的现有证据，以及这种方法的风险效益平衡。
通过 PubMed、Embase 和 Google Scholar 数据库搜索，确定相关的已发表文献。在这篇叙述性综述中，总结并讨论了口服药物在住院个体中使用的疗效和安全性概况的现有证据。
尽管一些研究表明二甲双胍、噻唑烷二酮类、磺酰脲类和钠-葡萄糖共转运蛋白 2 抑制剂在医院环境中的使用具有一定效果，但缺乏有力的证据支持这些药物的使用。然而，一些设计良好的随机对照试验支持在 2 型糖尿病住院患者中使用二肽基肽酶-4 抑制剂。这些试验表明，二肽基肽酶-4 抑制剂具有良好的安全性和耐受性，与胰岛素降低血糖的疗效相当，并且当与胰岛素联合使用时，可减少胰岛素剂量，适用于血糖轻度至中度升高且临床状况稳定的患者。
对于某些住院患者群体，给予二肽基肽酶-4 抑制剂可能是一种安全有效的胰岛素替代方案。
