Episode 364: 364. The safety and efficacy of sodium–glucose cotransporter 2 inhibitor in hospitalized patients

Gao FM et al. A systematic review and meta-analysis on the safety and efficacy of sodium–glucose cotransporter 2 inhibitor use in hospitalized patients. Diabetes Care 2024 Dec 1; 47:2275. (https://doi.org/10.2337/dc24-0946)

Trial Results

SGLT-2 inhibitors, crucial in managing diabetes, kidney disease, and heart failure, have shown promising results in hospitalized patients

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. The meta-analysis, covering 23 randomized controlled trials with 20,000 participants, revealed:

1. No significant increase in ketoacidosis rates (0.21 vs. 0.14 per 100 person-years)

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1. Lower mortality and fewer readmissions in heart failure patients

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1. Reduced incidence of acute kidney injury overall

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These findings suggest that SGLT-2 inhibitors can be safely continued or initiated in hospitalized patients, particularly those with heart failure

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Limitations

However, it's important to note some limitations:

1. Potential underpowering: The study might not have had enough statistical power to detect small differences in ketoacidosis rates

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1. Risk underestimation: Including outpatient follow-up periods may have diluted the true risk of ketoacidosis during hospitalization

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1. Patient diversity: Only 30% of participants had diabetes, which might not fully represent the typical hospital population

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Conclusion

While the results are encouraging, caution is still advised. The study supports current recommendations for SGLT-2 inhibitor use in hospitalized patients, especially those with heart failure, but emphasizes the need for careful monitoring and individualized decision-making

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.This concludes our brief podcast on SGLT-2 inhibitors in hospitalized patients. Thank you for listening, and stay tuned for more updates on diabetes care and management.