Practical implementation of incretin-based therapy in hospitalized patients with type 2 diabetes

Abstract

Hyperglycemia in patients with and without a prior history of diabetes is an independent marker of morbidity and mortality in critically and noncritically ill patients. Improvement of glycemic control with insulin therapy has been shown to reduce hospital complications in patients with diabetes, but also results in increased rates of hypoglycemia, which have been linked to poor outcomes. Thus, alternative treatment options that can normalize blood glucose levels without undue hypoglycemia are being sought. Incretin-based therapies, such as glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors, stimulate insulin secretion in a glucose-dependent fashion, thus not causing hypoglycemia. Alternative points of view exist regarding insulin versus incretin therapy for the care of these patients. We have brought together the authors on the opposite sides of this discussion with the objective of providing a rational synthesis on how to achieve the best possible control of glycemia in the hospital, using both standard insulin approaches and incretin-based therapies to improve patient outcomes. This review examines the benefits of incretin-based therapy in improving glycemic control in hospitalized patients with stress-induced diabetes and in diabetic patients in critical care and non–critical care settings.

Keywords :

• Glycemia
• incretin
• inpatient
• type 2 diabetes

Acknowledgment

We would like to acknowledge and thank Kate Mann, PharmD, for editorial assistance. Dr. Defronzo’s salary is, in part, supported by the South Texas Veteran's Health Care System.

Declaration of interest

Stanley S. Schwartz, MD, FACP, FACE, is on the advisory board of Lilly, Amylin, Santarus, Johnson & Johnson, Merck, and Sanofi–Aventis, and is a member of the speakers’ bureaus of Lilly, Amylin, Santarus, Merck, Sanofi-Aventis, Novo Nordisk, Boehringer Ingelheim, Bristol Myers Squibb, and Astra-Zeneca. Ralph A. DeFronzo, MD, is on the advisory board of Amylin, Takeda, Bristol Myers Squibb, Boehringer-Ingelheim, Novo Nordisk, and Lexicon; is a member of the speakers’ bureaus of Novo Nordisk, Bristol Myers Squibb, and Janssen; and has grants from Amylin and Takeda. Guillermo E. Umpierrez, MD, FACP, FACE, is a member of the advisory board of Sanofi, Merck, and Boehringer Ingelheim, and has received research funding from Sanofi, Novo Nordisk, Merck, and Boehringer Ingelheim.