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

非胰岛素药物在住院 2 型糖尿病 (T2D) 患者中的使用

• 批准号: 10378149
• 负责人: Maya Fayfman
• 金额: $ 17.71万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10378149
• 关键词: Admission activity; Adult; Advisory Committees; Agonist; Antidiabetic Drugs; Biometry; Blood Glucose; Bolus Infusion; Cardiovascular system; Clinical; Clinical Investigator; Clinical Trials; Collaborations; Complex; Critical Illness; Data; Development Plans; Diabetes Mellitus; Dipeptidyl Peptidases; Discipline of Nursing; Drug usage; Economics; Emergency department visit; GLP-I receptor; Glucose; Goals; Guidelines; Health Care Costs; Healthcare Fees; Home; Hospital Costs; Hospitalization; Hospitals; Hyperglycemia; Hypoglycemia; Iatrogenesis; Injections; Inpatients; Insulin; Interdisciplinary Study; Kidney; Lead; Length of Stay; Lung; Measures; Medical; Medicine; Mentors; Metformin; Multiple Organ Failure; Non-Insulin-Dependent Diabetes Mellitus; Observational Study; Operative Surgical Procedures; Oral; Outcome; Patient Preferences; Patients; Pharmacotherapy; Pragmatic clinical trial; Prospective Studies; Randomized; Randomized Controlled Trials; Regimen; Reporting; Research; Research Training; Risk; Safety; Services; Sulfonylurea Compounds; Surveys; Systemic infection; Technology; Thiazolidinediones; Time; Training; Work; basal insulin; career; career development; clinical care; comparative efficacy; cost; diabetes management; diabetes mellitus nursing; efficacy evaluation; experience; glucose monitor; glycemic control; health economics; hospital readmission; improved; inhibitor; mortality; new technology; novel; optimal treatments; point of care; preference; prospective; standard of care; subcutaneous; tool

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.

抽象的 观察性研究和前瞻性研究报告了高血糖之间的关联 在医院和医院并发症，死亡率和更长的住院时间的率更高。 已证明胰岛素治疗可有效改善血糖控制和 减少住院患者的并发症。但是，胰岛素使用与 低血糖的高率很麻烦（每天最多4次注射），容易发生 如果在适当的时间不给予错误，并且可能不会为 释放。几项随机对照试验表明，非 - 的安全性和效率 医院高血糖治疗的胰岛素疗法。迄今为止没有研究， 但是，已经系统地评估了广泛的口服抗糖尿病药物（OAD） 医院环境。彼此之间，我们提出了一项随机对照的务实临床试验 比较住院患者的家用OAD与基本推注胰岛素的延续 接受了非ICU服务。我们的目标是确定温和患者的OAD是否 住院期间可以继续进行中等高血糖，以达到类似的血糖 控制基本推注胰岛素，而不会导致医院并发症增加或成本更高。 这项现实世界研究的发现将直接在管理方面为临床护理提供信息 医院的糖尿病。 此外，该建议将增强多方面的研究培训和职业 Fayfman博士成为独立临床研究者所必需的发展计划。 Fayfman博士将继续与经验丰富的心理和咨询团队一起工作 医院环境，生物统计学和健康经济学的临床试验专业知识。这个训练是 受到建立跨学科研究的机构承诺的支持 合作和推进Fayfmans博士在学术研究领域的职业。