A review of the effect of SGLT2 inhibitors on clinical and glycemic outcomes in hospitalized patients: data from studies that included patients with diabetes.

Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are a fairly new class of agents for diabetes that have demonstrated significant benefits in glycemic control and cardiovascular outcomes with outpatient use. The aim of this review is to provide an overview of the effect of SGLT2i use on glycemic control and clinical outcomes in the hospital setting.An electronic search of PubMed was conducted to analyze publications that assessed the inpatient use of SGLT2i and included patients with diabetes. We looked for original studies that compared SGLT2i to placebo or other antidiabetic agents as well as studies that compared the addition of SGLT2i to conventional care of diabetes or heart failure (HF) vs. conventional care alone. We collected data on parameters of glycemic control and clinical outcomes.Eighteen clinical trials and 17 retrospective studies were included in our review. Inpatient SGLT2i use was associated with positive clinical outcomes in patients with diabetes and HF, including improved diuretic response, increased urine output, and decreased levels of NT-proBNP. Use of SGLT2i does not appear to increase the risk of kidney injury. Regarding long-term outcomes, multiple studies reported decreased risk of HF rehospitalization and/or all-cause mortality among patients who started treatment while in the hospital. For glycemic control, SGLT2i appear to decrease the insulin dose requirements without increasing the risk of hypoglycemia. Data on hospital mortality and length of stay are equivocal.