Background: Glycemic control within goal blood glucose (BG) ranges is essential to minimize hospital complications for patients with type 2 diabetes mellitus (T2DM). Optimal treatment in the non–intensive care unit (ICU) setting includes a basal insulin containing regimen. Dipeptidyl peptidase-IV (DPP-IV) inhibitors have minimal hypoglycemia incidence and may be an appropriate bolus insulin replacement in the inpatient setting. Objective: To determine the effect of basal insulin plus DPP-IV inhibitor compared with basal plus bolus insulin in hospitalized patients with T2DM. Methods: This multicenter cohort study included adult patients with T2DM admitted to the non-ICU setting and prescribed either basal insulin plus DPP-IV inhibitor or basal plus bolus insulin. Propensity-score matching was performed for age, sex, Charlson Comorbidity Index, first BG reading during hospitalization, and hemoglobin A1C (A1C). The primary outcome was the difference in mean daily BG during hospitalization. Secondary outcomes included hospital length of stay (LOS), total daily dose (TDD) of insulin, hypoglycemic events, and mean daily BG in patients with an A1C >8%. Results: A total of 105 patients were included in each group. Mean daily BG during hospitalization was lower in the basal insulin plus DPP-IV inhibitor group (199.3 ± 52.5 vs 213.6 ± 45.8 mg/dL; P = 0.04). There was a significant difference in hospital LOS (5 [interquartile range = 3-8] vs 6 [4-11] days; P = 0.02) and short-acting insulin TDD (11.6 ± 9.1 vs 20.5 ± 21.2 units; P < 0.001). No differences were observed in basal insulin TDD and hypoglycemia. There was no difference in mean daily BG in the subgroup analysis of patients with a A1C >8%. Conclusions and Relevance: A significant difference in mean daily BG and hospital LOS was found with a basal insulin plus DPP-IV inhibitor regimen. Use of a DPP-IV inhibitor to replace bolus insulin in hospitalized patients with T2DM should be considered.

Background: The American Diabetes Association recommends discontinuing non-insulin antihyperglycemic therapy during hospitalization and utilizing a basal insulin-containing regimen for patients with type 2 diabetes mellitus (T2DM). Limited research is available on the role of dipeptidyl peptidase-IV (DPP-IV) inhibitors in an inpatient real-world patient population. Objective: To determine the efficacy of DPP-IV inhibitor therapy in hospitalized patients with T2DM. Methods: Adult patients with T2DM and received at least one dose of DPP-IV inhibitor during hospitalization were included. The primary outcome was to determine the mean daily blood glucose (BG) readings in the overall patient population. Secondary outcomes included comparing study groups and evaluating mean daily blood glucose, hospital length of stay (LOS) and incidence of hypoglycemia. Results: One hundred and ninety-two patients were identified: 39 patients (20.3%) received DPP-IV inhibitor monotherapy, 104 (54.2%) received DPP-IV inhibitor plus oral antihyperglycemics and 49 (25.5%) received DPP-IV inhibitor plus insulin. Mean daily BG in the entire study population was 158.7 mg/dL (131-187.5). Mean daily BG was significantly different between groups (117 mg/dL [103.5-132.3] vs. 160.7 mg/dL [133-181.1] vs. 179.4 mg/dL [153.8-216.6]; (P < 0.001). Hypoglycemic events were higher in the DPP-IV inhibitor plus insulin group (2.6% vs. 3.8% vs. 16.3%; P = 0.008). There were no significant differences in hospital LOS (2 days [1-4] vs. 3 days [1-5] vs. 4 days [2-6.5]; P = 0.051). Conclusions: Inpatient DPP-IV inhibitor use was associated with mean daily BG within goal range. Administering DPP-IV inhibitors in the inpatient setting should be considered in hospitalized patients with controlled T2DM.