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之间的联系 住院和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在改善血糖控制和 减少住院患者的并发症。然而，胰岛素的使用与 低血糖发生率高，给药很麻烦(每天最多注射4次)，容易发生 错误，如果没有在适当的时间给药，可能不会通知最佳治疗 出院。几个随机对照试验已经证明了非 胰岛素治疗在医院高血糖治疗中的应用。到目前为止还没有研究， 然而，已经系统地评估了广泛的口服抗糖尿病药物(OAD)在 医院环境。因此，我们提出了一项随机对照的实用临床试验 住院患者持续服用家庭口服阿司匹林与基础胰岛素的比较 住进了非重症监护室。我们的目标是确定轻度到中度的患者是否服用OADs 住院期间可持续中度高血糖以达到类似的血糖水平 控制基础胰岛素推注，不会导致增加医院并发症或更高的费用。 这一真实世界的研究结果将直接为临床治疗提供参考。 糖尿病住院治疗。 此外，这项建议还将加强多方面的研究培训和职业生涯 费夫曼博士成为一名独立的临床研究员所需的发展计划。 Fayfman博士将继续与经验丰富的指导和咨询团队合作， 在医院环境、生物统计学和卫生经济学方面的临床试验方面的专业知识。这次培训是 由建立跨学科研究的机构承诺支持 合作和推进费夫曼斯博士在学术研究方面的事业。

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.