Use of Metformin (Met) and Thiazolidinediones (TZD) in Non-Critically Ill Hospitalized Patients with Type 2 Diabetes Mellitus (T2DM) in a Large Community Hospital

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 839-872-Diabetes & Obesity Management
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-853
Priyanka Iyer*1, Regina Falato2 and Sally M Pinkstaff3
1Johns Hopkins University/ Sinai Hospital of Baltimore, Baltimore, MD, 2Sinai Hospital of Baltimore, Baltimore, MD, 3Johns Hopkins University School of Medicine, Baltimore, MD
Background: Because hyperglycemia in hospitalized patients is associated with adverse outcomes, recent guidelines regarding inpatient glycemic targets have been published by the American Diabetes Association and the Endocrine Society (1, 2).  Although insulin is the preferred therapy on admission with discontinuation of oral agents, many patients with T2DM have their home regimen continued.  Because of prescribing contraindications or precautions, the use of Met/TZD in the hospital may be problematic (3, 4). This study assesses the frequency, safety, and efficacy of Met/TZD in hospitalized patients with T2DM.

Objectives: To identify the frequency of Met/TZD use in non-critically ill patients with T2DM, to report the presence of contraindications or risks factors for adverse drug events (ADEs), and to assess efficacy on glycemic control.

Design: Retrospective chart review study

Setting: Community teaching hospital

Population: 72 patients with T2DM admitted to the medical/ surgical wards in January 2011 were administered Met/TZD. 60 patients received Met, 10 received TZDs, and 2 both.These agents were used alone or with other oral antihyperglycemic agents and/or insulin. 9 patients with ≤3 fingersticks (FS) / 24 hours for >50% of the hospital stay were excluded in the glycemic data.

Outcomes: Percentage of hospitalized patients with T2DM administered Met/TZD; Percentage with contraindications or risk factors for ADEs; Episode rates of hyperglycemia (FS>180 mg/dl) and hypoglycemia (FS<70 mg/dl), calculated as the number of abnormal FS divided by the total FS number for each patient.

Results: In 1 month, 15% (72/490) of patients with T2DM were administered Met/TZD. Forty one (57%) had at least one contraindication or precaution to either drug. In the Met group, 10 (16%) had an elevated Cr(≥1.4-women; ≥1.5-men), 2 (3%) had a high anion gap, 10 (16%) received IV contrast, 6 (10%) received loop diuretics, 17 (27%) had pulmonary disease and 13 (21%) had cardiac disease. In the TZD group, 1 (8%) had congestive heart failure and 3 (25%) had cardiac disease. While on Met/TZD, 35 out of 63 patients (55%) had hyperglycemic episode rates ≥25%. 3 had hypoglycemia.

Conclusions: Met/TZD remain in use in the hospital setting despite current guidelines. More than 55% of patients administered Met/TZD had contraindications or risk factors for ADEs. The inclusion of Met/TZD in a treatment regimen did not result in optimal glycemic control.

(1)  Moghissi E, Korytkowski M, DiNardo M, Einhorn D, Hellman R, Hirsch I, Inzucchi S, Ismail-Beigi F, Kirkman S, Umpierrez G 2009 American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control. Diabetes Care 32: 1119–1131. (2)  Umpierrez G, Hellman R, Korytkowski M, Kosiborod M, Maynard G, Montori V, Seley J, Van den Berghe G 2012 Management of Hyperglycemia in  Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice Guideline. J ClinEndocrinolMetab 97: 16-38.  (3 ) http://www.uptodate.com/contents/pioglitazone-drug-information?source=search_result&search=prescribing+guidelines+for+pioglitazone&selectedTitle=5%7E150. Lexicomp. Version 38. (4) http://www.uptodate.com/contents/metformin-drug-information?source=search_result&search=prescribing+guidelines+for+metformin&selectedTitle=17%7E150. Lexicomp. Version 44

Nothing to Disclose: PI, RF, SMP

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm