Use of Non-Insulin Agents in Hospitalized Patients with Type 2 diabetes (T2D)

摘要 观察性和前瞻性研究已经报道了高血糖症 住院时间长，住院并发症发生率高，死亡率高，住院时间长。 胰岛素治疗已被证明可有效改善血糖控制， 减少住院病人的并发症。然而，胰岛素的使用与 低血糖发生率高，给药繁琐（每天最多注射4次），易于 错误，如果没有在适当的时间给药，可能无法告知最佳治疗 放电几项随机对照试验已经证明了非药物的安全性和有效性。 胰岛素治疗在医院高血糖症的管理。迄今为止没有研究， 然而，已经系统地评估了广泛的口服降糖药物（OAD）， 医院设置。因此，我们提出了一项随机对照的实用临床试验， 在住院患者中比较家庭OAD与基础餐时胰岛素的持续使用 接受非ICU服务。我们的目标是确定OAD是否适用于轻度至 在住院期间可持续中度高血糖， 控制基础餐时胰岛素，而不会导致医院并发症增加或费用增加。 这项真实世界研究的结果将直接告知临床护理管理， 糖尿病住院 此外，这项建议将加强多方面的研究培训和职业生涯 Fayfman博士成为独立临床研究者所需的发展计划。 博士Fayfman将继续与经验丰富的指导和咨询团队一起工作， 在医院环境中的临床试验，生物统计学和卫生经济学方面的专业知识。此次培训是 由建立跨学科研究的机构承诺支持 合作和推进Fayfmans博士的学术研究事业。

Abstract Observational and prospective studies have reported on the association between hyperglycemia in the hospital and higher rates of hospital complications, mortality, and longer length of stay. Insulin therapy has been demonstrated to be effective in improving glycemic control and reducing complications among hospitalized patients. Insulin use, however, is associated with high rates of hypoglycemia, is cumbersome to administer (up to 4 injections daily), prone to error if not administered at appropriate times and may not inform optimal treatment for discharge. Several randomized controlled trials have demonstrated safety and efficacy of non- insulin therapies in the management of hyperglycemia in the hospital. No studies to date, however, have systematically evaluated a broad range of oral antidiabetic drugs (OAD) in the hospital setting. Accordingly, we propose a randomized controlled pragmatic clinical trial to compare continuation of home OADs to basal bolus insulin among hospitalized patients admitted to non-ICU services. Our goal is to determine whether OADs in patients with mild to moderate hyperglycemia can be continued during hospitalization to achieve similar glycemic control to basal bolus insulin without leading to increased hospital complications or higher costs. The findings of this real-world study will directly inform clinical care in the management of diabetes in the hospital. In addition, this proposal will enhance the multifaceted research training and career development plan necessary for Dr. Fayfman to become an independent clinical investigator. Dr. Fayfman will continue to work alongside an experienced mentoring and advisory team with expertise in clinical trials in hospital settings, biostatistics, and health economics. This training is supported by an institutional commitment to establishing interdisciplinary research collaborations and advancing Dr. Fayfmans’ career in academic research.