Written by Peter Liu
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A meta-analysis of sodium-glucose cotransporter 2 (SGLT2) inhibitor use in the inpatient setting showed its safety across multiple outcome measures. More patients developed ketoacidosis, though the difference was not statistically significant.
SGLT2 inhibitor use in inpatients appears to be safe – but mind the anion gap!
The benefits of SGLT2 inhibitors are well established in diabetes, heart failure, chronic kidney disease, and myocardial infarction. As a result, we are gaining inpatient experience with these medications and seeing admissions for rare complications with their use, such as ketoacidosis states including euglycemic diabetic ketoacidosis.
Today’s featured meta-analysis analyzed several patient outcomes from RCTs across a heterogeneous collection of inpatient RCTs, including heart failure (n≈2000), myocardial infarction (n≈10,000), diabetes trials (n≈100), COPD and COVID-19 trials (n≈5000), cardiac surgery trials (n≈300), and hyponatremia studies (n=87). Of these inpatients, 29.5% had type 2 diabetes. SGLT2 inhibitors were compared to standard care, placebo, or other diuretics in the studies. The findings generally showed that SGLT2 inhibitor use had comparable outcomes to its comparators. Notably, in heart failure trials, SGLT2 inhibitor use was associated with fewer readmissions and urgent visits (OR 0.64, 95%CI 0.47-0.86; p<0.01) and lower mortality rates (OR 0.74, 0.56-0.98; p=0.03). Among all included RCTs, a lower incidence of acute kidney injury (OR 0.76, 0.60-0.97; p=0.03) was observed. The main safety concern was increased numbers of ketoacidosis in the SGLT2 inhibitor arm (rate ratio 1.50, 0.0.56-4.23; p=38), though ketoacidosis events were rare (0.10-0.16% of patients). Where reported, all patients with ketoacidosis had diabetes.
Overall, these findings support the use of SGLT2 inhibitor in the inpatient setting, particularly heart failure, when clinically appropriate.
How will this change my practice?
While SGLT2 inhibitors are not my first-line choice for most inpatient problems, I find myself using them more in the hospital. Based on this study, I am encouraged to use them for inpatients with heart failure, especially those refractory to diuretics. It is also prudent to monitor the anion gap carefully when using SGLT2 inhibitors in the inpatient setting.
Source
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(12):2275-2290. doi: 10.2337/dc24-0946. PMID: 39602586.
