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

Video Transcription

Video Summary

This lecture focused on how hospitalists should manage diabetes medications during hospitalization and at discharge, especially newer agents such as GLP-1 receptor agonists, SGLT2 inhibitors, and DPP-4 inhibitors. Dr. Nzuchi reviewed type 2 diabetes pathophysiology and explained how different drug classes target different defects in glucose regulation. He highlighted a major shift in treatment guidelines: therapy is now increasingly guided by comorbidities such as ASCVD, heart failure, and chronic kidney disease, not just A1c.

Key inpatient points included:  
- <strong>Metformin</strong> should usually be stopped in acute illness, especially with AKI, acidosis, or volume depletion.  
- <strong>Sulfonylureas</strong> are generally avoided if patients are not eating due to hypoglycemia risk.  
- <strong>DPP-4 inhibitors</strong> can often be continued if the patient is stable.  
- <strong>SGLT2 inhibitors</strong> are usually held in sick hospitalized patients because of euglycemic DKA risk and volume issues.  
- <strong>GLP-1 receptor agonists</strong> are often stopped on admission due to appetite suppression, cost, and limited inpatient use.  
- <strong>Insulin</strong> remains the most flexible inpatient therapy.

Dr. Burkutta emphasized that hospitalization is an opportunity to screen, optimize therapy, and improve transitions of care. He stressed the importance of quality, value-based care, and using hospitalization to identify patients who should be on evidence-based therapies but are not.

The Q&A covered steroid-induced hyperglycemia, combined sulfonylurea and insulin use, discharge planning after DKA, restarting SGLT2 inhibitors after UTI/urosepsis, hypoglycemia risk in non-diabetic heart failure patients, dehydration risk, and medication cost/access.

Meta Tag

Concept Type 2 Diabetes

Concept Insulin

Concept SGLT-2 Inhibitors

Concept Inpatient Insulin Regimen

Concept Insulin Resistance

Keywords

diabetes management

hospitalization

discharge planning

GLP-1 receptor agonists

SGLT2 inhibitors

DPP-4 inhibitors

metformin

sulfonylureas

insulin therapy

euglycemic DKA

Type 2 Diabetes

Insulin

SGLT-2 Inhibitors

Inpatient Insulin Regimen

Insulin Resistance