Diabetes mellitus (DM) is one of the most common diseases worldwide, affecting roughly 537 million adults between the ages of 20 and 791. In the United States, it is estimated that 34.1 million adults, or 13% of the adult population have some form of diabetes, and this number is rapidly increasing2. Given the large burden of patients with diabetes, it is not surprising that management of hyperglycemia is a commonly encountered challenge in hospitalized patients. In 2016, 7.8 million hospital discharges included a diagnosis of diabetes, with a prevalence of DM in about 25% of all noncritically ill hospitalized patients2,3. Furthermore, it is estimated that one-third of cases of inpatient hyperglycemia occur in patients without a prior diagnosis of diabetes4. Current guidelines define hyperglycemia as a serum glucose >140 mg/dL3,5. Common causes for development of hyperglycemia include uncontrolled diabetes, ineffective insulin dosing, glucocorticoid use, stress hyperglycemia, and enteral nutrition3. Inpatient glucose targets may vary, but in most noncritically ill adults, glucose should be maintained between 100-180 mg/dL3,5-7.

The current standard therapy for inpatient hyperglycemia is insulin, and in select patients with mild hyperglycemia, dipeptidyl peptidase 4 inhibitors (DPP4i) may be considered3,5. In recent years, several landmark trials demonstrated numerous benefits provided by outpatient use of sodium glucose-like cotransporter 2 inhibitors (SGLT2i) towards improved cardiovascular outcomes, heart failure admissions, and reduction in chronic kidney disease (CKD) progression, in addition to providing glycemic control for patients with Type 2 DM (T2DM) without increasing the risk of hypoglycemia8, 9, 10, 11, 12, 13, 14. Given the many benefits of SGLT2i, one may consider this class as a potential therapy for inpatient management of hyperglycemia. Current clinical practice guidelines on inpatient management of hyperglycemia do not recommend the use of SGL2i due to inconclusive evidence towards safety3,5, 6, 7. These safety concerns include classical diabetic ketoacidosis (DKA), euglycemic diabetic ketoacidosis (eDKA), hypovolemia, and urinary tract infection (UTI). Data regarding these adverse outcomes in hospitalized patients is limited but evolving. We will discuss the risks of using SGLT2i for inpatient hyperglycemia management and why standard insulin therapy or use of DPP4i may be preferred.