In This Issue of Diabetes Care

Continued Use of SGLT2 Inhibitors in Hospital Settings Reduces Mortality in DiabetesThe continued use of previously prescribed sodium-glucose cotransporter 2 (SGLT2) inhibitors in the inpatient setting appears to be associated with 45% lower hospital mortality rate, according to Singh et al. (p.933).When they compared these rates with those of patients who discontinued the diabetes drugs, they also found no overall difference in rates of acute kidney injury and a modestly shorter length of hospital stay.Based on the findings, the authors suggest that there may be a role for noninsulin-based pharmacotherapy in inpatient settings.Current recommendations indicate insulin for the management of hyperglycemia in nearly all hospitalized patients with diabetes, as abnormal glucose control in the hospital setting has been associated with poor clinical outcomes.The findings come from a nationwide cohort study that used data on acute care hospitalizations, over ~8 years between 2013 and 2021.After a series of exclusions, the authors identified ~36,500 admissions of individuals with diabetes, just under 6,000 of whom were continued on SGLT2 inhibitors after admission, with the balance discontinuing the therapy.The authors found there were 9.2 in-hospital deaths per 1,000 admissions in the group that continued SGLT2 inhibitors compared with 16.8 deaths per 1,000 admissions in the group that discontinued their use.This translated to 45% lower relative mortality, which remained following adjustment for confounders and across multiple sensitivity analyses."With our retrospective study design, we cannot identify causality or reasons that led to continuation or discontinuation of SGLT2 inhibitors," said author Elias K. Spanakis."However, we provide important evidence to support the continued use of SGLT2 inhibitors in the hospital setting in those patients who are receiving them in the ambulatory setting."Despite the limitations, the authors propose several mechanisms that could be behind the observations."Most importantly, we show that the reason for using SGLT2 inhibitors in the hospital environment is not for achieving better glycemic control, but because they have other, possibly cardiorenal, protective effects leading to reduced mortality."