Safety and efficacy of non-insulin therapy in non-critically ill hospitalized patients with type 2 diabetes mellitus

Irit Ayalon-Dangur, Tanya Babich, Maayan Huberman Samuel, Leonard Leibovici, Alon Grossman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Clinical guidelines recommend insulin as the mainstay of therapy for hospitalized patients with diabetes mellitus. The aim of the current study is to evaluate safety and efficacy of non-insulin anti-hyperglycemic therapy in hospitalized patients. Materials and methods: Systematic review and meta-analysis of randomized controlled trials (RCTs) examining treatment of hospitalized patients with type 2 diabetes with insulin vs non-insulin therapy. We searched PubMed and the Cochrane Library for RCTs published from inception to November 30, 2022. Primary outcomes were 30-day mortality and hypoglycemic events during hospitalization. This meta-analysis includes two parts, the first is a comparison between insulin and non-insulin therapy and the second is a comparison between insulin only and a combination of insulin+non-insulin therapy. Results: A total of 14 randomized control studies and 1570 patients were included. There was a lower incidence of 30-day mortality in the insulin+non-insulin group compared with the insulin group without statistical significance, RR 0.64 (95%CI 0.30–1.35). Hypoglycemic events were significantly lower with the non-insulin therapies compared to insulin therapy, RR 0.23 (95%CI 0.09–0.55). Mean daily glucose levels were significantly lower in the insulin+non-insulin group compared to the insulin group by 10.83 mg/dL (95%CI -14.78-(-6.87)). Conclusions: Non-insulin either with or without insulin, results in lower rates of hypoglycemia. Non-insulin+insulin is more effective than insulin alone in reducing blood glucose levels. Non-insulin-based therapy is safe and effective for control of hyperglycemia. Insulin combined with non-insulin drugs seems to be the preferred treatment option for the majority of hospitalized patients with type 2 DM in the non-critical care setting.

Original languageEnglish
Pages (from-to)106-118
Number of pages13
JournalEuropean Journal of Internal Medicine
Volume116
DOIs
StatePublished - Oct 2023

Keywords

  • Hospitalization
  • Inpatients
  • Insulin
  • Non-insulin
  • Therapy
  • Type 2 diabetes mellitus

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