Introduction: Type 2 diabetes mellitus is a disease with a high prevalence worldwide and its incidence increases, so it is frequent that patients who are hospitalized for various causes have diabetes. In this population group, the American Diabetes Association (ADA) recommends insulin as the drug of choice, despite the fact that they receive other antidiabetic drugs in their outpatient treatment. Therefore, the objective of this study is to evaluate the non-inferiority of drugs with incretin effect (IV dipeptidyl peptidase inhibitors and GLP-1 agonists) when compared with insulin in the hospital setting.
Methodology: A systematic review of the literature and meta-analysis we were carried out. The literature search was carried out in the Pubmed, Embase, Science direct, Scielo, Scopus, Open Gray and Google scholar databases. Randomized clinical trials were included comparing treatment with drugs with incretin effect vs basal bolus insulin regimen in hospitalized patients. The primary outcome was glycemic control (normoglycemia) and as secondary outcomes hyper or hypoglycemia. Odds Ratios (ORs) were calculated as measures of association with their 95% confidence intervals and I2 indices in each analysis as a measure of heterogeneity, using the Review Manager software. For interpretation, 1.25 was arbitrarily set as the non-inferiority limit.
Results: 116 references were identified as possibly eligible and 7 studies were included. Five of them compared DPP-4 inhibitors vs insulin and 2 with GLP-1 agonists vs insulin. The OR for normoglycemia was 1.35 (95% CI 1.27-1.42, I2 = 95%) when comparing incretin drug (both types) vs insulin, while for the comparator incretin drug associated with insulin vs insulin it was 1.5 (95% CI 1.00 -2.27, I2 = 95%). For hyperglycemia in both comparisons, the OR were 0.81 (95% CI 0.63-1.04, I2 = 84%) and 0.63 (95% CI 0.50-0.80, I2 = 81%), respectively. In the hypoglycemic outcome, the OR was 0.15 (95% CI 0.06 to 0.4, I2 = 23%) for incretin drug vs insulin and 0.44 (95% CI 0.18-1.06, I2 = 50%) for incretin drug associated with insulin vs insulin.
Conclusion: incretin drugs were inferior to insulin for the outcome of normoglycemia in hospitalized diabetic patients. In contrast, they were not inferior with respect to hyperglycemia and hypoglycemia outcomes. Further studies are required to get a recommendation for the use of these drugs in the hospital setting.
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