From the Guidelines
Sitagliptin can be given in the acute hospital setting, particularly for patients with type 2 diabetes who are stable and have been taking it at home, as evidenced by a recent study published in Diabetes Care 1. When considering the use of sitagliptin in the hospital, it's essential to weigh the benefits and limitations of this medication. The standard oral dose is 100 mg once daily, with dose reductions needed for patients with renal impairment (50 mg daily for eGFR 30-45 mL/min and 25 mg daily for eGFR <30 mL/min) 1. Some key points to consider when using sitagliptin in the hospital setting include:
- Sitagliptin works by inhibiting DPP-4, which increases incretin hormones that stimulate insulin release and reduce glucagon secretion in a glucose-dependent manner, making it unlikely to cause hypoglycemia when used alone 1.
- In the hospital, sitagliptin may be continued in patients previously taking it at home who are eating regularly and have stable renal function 1.
- However, for acute hyperglycemia management in hospitalized patients, insulin therapy is generally preferred due to its rapid action, titratability, and effectiveness across all levels of hyperglycemia 1.
- Sitagliptin should be avoided in patients with type 1 diabetes, diabetic ketoacidosis, or those who are NPO (nothing by mouth).
- It's also important to monitor renal function while in the hospital as changes may necessitate dose adjustments or discontinuation 1. Overall, the use of sitagliptin in the hospital setting should be individualized and based on the patient's specific clinical circumstances, with careful consideration of the potential benefits and limitations of this medication 1.
From the Research
Administration of Sitagliptin in Acute Hospital Setting
- Sitagliptin can be given in an acute hospital setting for the management of type 2 diabetes mellitus, as evidenced by several studies 2, 3.
- A multicentre, prospective, open-label, non-inferiority randomised trial (Sita-Hospital) compared the safety and efficacy of sitagliptin plus basal insulin with a basal-bolus insulin regimen for the management of patients with type 2 diabetes in general medicine and surgery in hospitals, and found that treatment with sitagliptin plus basal insulin is as effective and safe as, and a convenient alternative to, the labour-intensive basal-bolus insulin regimen 2.
- A pilot, randomized, controlled study investigated the safety and efficacy of sitagliptin therapy for the inpatient management of general medicine and surgery patients with type 2 diabetes, and found that treatment with sitagliptin alone or in combination with basal insulin is safe and effective for the management of hyperglycemia in general medicine and surgery patients with type 2 diabetes 3.
Efficacy and Safety of Sitagliptin
- Sitagliptin has been shown to be effective in improving glycaemic control in patients with type 2 diabetes, with a low risk of hypoglycaemia and a neutral effect on body weight 4, 5, 6.
- The efficacy and safety of sitagliptin have been demonstrated in various clinical trials, including its use as monotherapy, initial combination therapy, or add-on therapy to metformin or to other antihyperglycaemic drugs, with or without metformin 4, 5, 6.
Hospital Management of Type 2 Diabetes
- Sitagliptin can be used as an alternative to basal-bolus insulin regimen for the management of hyperglycemia in patients with type 2 diabetes admitted to general medicine and surgery services in hospital in the non-intensive-care setting 2.
- The use of sitagliptin in the hospital setting can reduce the total daily insulin dose and the number of insulin injections, making it a convenient option for the management of hyperglycemia in patients with type 2 diabetes 3.