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 观察性和前瞻性研究报告了高血糖之间的关联 医院并发症发生率、死亡率和住院时间更长。 胰岛素治疗已被证明可有效改善血糖控制和 然而，减少住院患者的并发症与胰岛素的使用有关。 低血糖发生率高，管理繁琐（每天最多注射 4 次），容易发生 如果没有在适当的时间给药，可能会出现错误，并且可能无法提供最佳治疗 几项随机对照试验已证明非治疗的安全性和有效性。 迄今为止，尚无医院内治疗高血糖的胰岛素疗法。 然而，系统地评估了广泛的口服抗糖尿病药物（OAD） 因此，我们提出一项随机对照实用临床试验。 比较住院患者继续使用家庭 OAD 与基础推注胰岛素的情况 我们的目标是确定入住非 ICU 服务的患者是否患有 OAD。 住院期间可以继续中度高血糖以达到相似的血糖水平 控制基础推注胰岛素，不会导致医院并发症增加或费用增加。 这项现实世界研究的结果将直接为临床护理管理提供信息 糖尿病在医院。 此外，该提案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必需的发展计划。 费夫曼博士将继续与经验丰富的指导和咨询团队一起工作 该培训涉及医院环境临床试验、生物统计学和卫生经济学方面的专业知识。 以建立跨学科研究的机构承诺为支持 合作并推进费夫曼斯博士的学术研究生涯。