Should Januvia (Sitagliptin) Be Held During Hospitalization?
Januvia (sitagliptin) should generally be held during hospitalization, with insulin being the preferred treatment for managing hyperglycemia in hospitalized patients with diabetes. 1
Primary Recommendation
Insulin is the preferred treatment for hyperglycemia in hospitalized patients, and oral glucose-lowering medications like sitagliptin should typically be discontinued during the acute hospitalization period. 1
The American Diabetes Association explicitly states that "in most instances, insulin is the preferred treatment for hyperglycemia in hospitalized patients," though acknowledges that "in certain circumstances, it may be appropriate to continue home regimens including oral glucose-lowering medications." 1
When Sitagliptin May Be Continued
If oral medications are held in the hospital, there should be a protocol for resuming them 1-2 days before discharge to ensure smooth transition back to outpatient regimens. 1
Continuation of home oral antidiabetic regimens may be appropriate in hemodynamically stable patients who are eating normally, have good glycemic control, and do not have acute illness severity requiring intensive management. 1
Rationale for Holding Sitagliptin
Hospitalized patients often have unpredictable oral intake, are NPO (nothing by mouth), or have variable nutritional status, making oral agents less reliable for glycemic control. 1
Acute illness, stress hyperglycemia, and use of medications that cause hyperglycemia (such as corticosteroids) require more flexible and titratable glucose management than oral agents can provide. 1
Insulin regimens allow for precise adjustment based on changing clinical status, nutritional intake, and glucose monitoring results every 4-6 hours in non-eating patients or before meals in eating patients. 1
Preferred Inpatient Insulin Regimens
For non-critically ill patients with poor oral intake or NPO status: Basal insulin or basal plus bolus correction insulin regimen is preferred. 1
For non-critically ill patients with good nutritional intake: An insulin regimen with basal, prandial, and correction components is preferred. 1
Sliding scale insulin alone is strongly discouraged as the sole inpatient regimen. 1
Special Considerations for DPP-4 Inhibitors
While sitagliptin itself has not been specifically associated with heart failure risk, saxagliptin (another DPP-4 inhibitor) has been associated with increased risk of heart failure hospitalization, and the FDA recommends considering discontinuation in patients who develop heart failure. 1
This concern is particularly relevant for hospitalized patients who may have underlying cardiac issues or fluid overload.
Discharge Planning
Reinitiate sitagliptin 1-2 days before discharge if it was part of the patient's home regimen and the patient is clinically stable, eating well, and ready to resume outpatient diabetes management. 1
Ensure the patient has appropriate follow-up and understands their discharge medication regimen, as hospitalization represents a critical opportunity to optimize diabetes management. 1
Common Pitfalls to Avoid
Do not rely on oral agents alone in acutely ill hospitalized patients, as this increases risk of inadequate glycemic control and complications.
Do not continue sliding scale insulin as the only regimen after holding oral agents—this approach is strongly discouraged and associated with poor outcomes. 1
Do not forget to restart home medications before discharge, as failure to do so can lead to poor glycemic control and readmission. 1