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To compare the efficacy and safety of basal-plus (BP) insulin regimen with or without sitagliptin in non-critically ill patients with type 2 diabetes (T2D). This open-label, randomized clinical trial included inpatients with a previous diagnosis of T2D and blood glucose (BG) between 180 and 400 mg/dL. Participants received basal and correctional insulin doses (BP regimen) either with or without sitagliptin. The primary outcome was the difference in the mean daily BG among the groups. Seventy-six patients (mean age 60 years, 64 % men) were randomized. Compared with BP insulin therapy alone, the sitagliptin-BP combination led to a lower mean daily BG (158.8 vs 175.0 mg/dL, P = 0.014), a higher percentage of readings within a BG range of 70–180 mg/dL (75.9 % vs 64.7 %, P < 0.001), and a lower number of BG readings >180 mg/dL (P < 0.001). Sitagliptin-BP resulted in fewer basal and supplementary insulin doses (P = 0.024 and P = 0.017, respectively) and lower daily insulin injections (P = 0.023) than those with insulin alone. The proportion of patients with hypoglycemia was similar in the two groups. For inpatients with T2D and hyperglycemia, the sitagliptin and BP regimen combination is safe and more effective than insulin therapy alone. Clinicaltrials.gov identifier: NCT05579119 [Display omitted] • Previous studies have found that basal and correctional insulin doses (basal-plus regimen) with sitagliptin are similar to the basal-bolus insulin regimen in managing hyperglycemia in a hospital setting. However, whether this combination is better than basal-plus regimen alone is unclear. • Our research showed that combining sitagliptin with a basal-plus insulin regimen leads to lower daily blood glucose levels, a comparable risk of hypoglycemia, and lower insulin doses than the basal-plus regimen alone. • These results are significant because using DPP-4 inhibitors with basal-plus insulin therapy simplifies hospital diabetes management for healthcare professionals, improves treatment adherence, and, by extension, leads to better patient outcomes. [ABSTRACT FROM AUTHOR]