Rapid Clinical Updates: Great Debates in Diabetes: Updates for the Hospitalist-Handout

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This article from hospitalmedicine.org highlights essential knowledge for hospitalists regarding Type 2 diabetes therapies, emphasizing recent advancements and patient-centered approaches. Over the past 5-10 years, newer classes of diabetes medications have emerged that not only manage blood glucose levels but also reduce the onset or progression of comorbidities. Modern care focuses beyond just achieving target A1C levels to also reducing cardiovascular and renal complications, which are common in diabetes patients.<br /><br />The American Diabetes Association (ADA) guidelines now emphasize addressing cardiovascular disease as a critical component of diabetes management. Two key medication classes—GLP-1 receptor agonists and SGLT2 inhibitors—have gained prominence due to their ability to lower glucose and simultaneously provide heart and kidney protection as well as promote weight loss. Recent trials highlight the interconnected nature of cardiology, endocrinology, and nephrology in managing diabetes effectively.<br /><br />In the hospital setting, the typical approach is to temporarily hold a patient’s home diabetes regimen and use symptom/sign (S/S) or low-dose physiological insulin therapy. If the patient is stable and eating, continuing the home regimen with insulin or sulfonylurea dose adjustments to avoid hypoglycemia is possible. Hospitalization provides an opportunity to reassess diabetes management using the "3 C’s": Compliance, Control, and Comorbidities, and to offer brief inpatient education on diabetes survival skills.<br /><br />Upon discharge, planning should begin early to tailor the diabetes regimen based on what the patient can manage at home. Starting new agents at discharge may be difficult, so providing guidance on an optimal regimen and ensuring prescriptions, supplies, and outpatient follow-up are in place is critical for ongoing diabetes care. This approach supports safer transitions and improved long-term outcomes for hospitalized patients with Type 2 diabetes.

Keywords

Type 2 diabetes

hospitalists

diabetes therapies

GLP-1 receptor agonists

SGLT2 inhibitors

cardiovascular complications

renal complications

ADA guidelines

insulin therapy

diabetes management