Association of continued use of SGLT2 inhibitors from the ambulatory to inpatient setting with hospital outcomes in patients with diabetes mellitus: A nationwide cohort study

Objective: Limited data are available on continuation of outpatient sodium glucose co-transporter-2 inhibitors (SGLT2i) during hospitalization. The objective was to evaluate associations of SGLT2i continuation in the inpatient setting with hospital outcomes. Research Design and Methods: Nationwide cohort study utilizing Veterans Affairs (VA) healthcare system’s data of acute-care hospitalizations between April 1, 2013, and August 31, 2021. 36,505 admissions of diabetes mellitus (DM) patients with an outpatient prescription for SGLT2i prior to hospitalization were included. Exposure defined as SGLT2i continuation during hospitalization. Admissions where SGLT2i was continued were compared to admissions where it was discontinued. Primary outcome was in-hospital mortality. Secondary outcomes were acute kidney injury (AKI) and length of stay (LOS). Negative binomial propensity score weighed and zero truncated analyses were used to compare outcomes and adjusted for multiple covariates, including demographics and comorbidities. Results: Mean (standard error) age was 67.2 (0.1) and 67.5 (0.1) years (p=0.03), male 97.0% and 96.6% (p=0.1), white 71.3% and 72.1%, black 20.8% and 20.5% (p=0.52) in SGLT2i continued versus SGLT2i discontinued groups, respectively. After covariate adjustment (age, sex, race, BMI, and Elixhauser Comorbidities, procedures/surgeries, and insulin use), SGLT2i continued group had a 45% lower mortality rate (IRR 0.55, 95%CI 0.42,0.73, p<0.01), no difference in AKI (IRR 0.96, 95%CI 0.90,1.02, p=0.17) and decreased LOS [4.7 vs. 4.9 days (IRR 0.95, 95%CI 0.93,0.98, p<0.01)], versus SGLT2i discontinued. Similar associations were observed in multiple sensitivity analyses. Conclusions: Continued SGLT2i during hospitalization among patients with diabetes was associated with lower mortality, no increased AKI, and shorter LOS.