Diabetes Ward Management—Room for Improvement

Abstract

Background: Diabetes control frequently deteriorates during hospitalisation and changes to management are often required. Aim: To evaluate the prevalence, diabetes type, admitting unit and glycaemic control of hospital inpatients with diabetes mellitus and the use of insulin‐to‐test orders (sliding scales). Method: Information on demographics, glycaemic control and insulin‐to‐test orders were collected for inpatients with diabetes mellitus by surveying medical records, 48 hours of blood glucose levels (BGLs) and drug charts. Results: Of the 698 inpatients, 108 (15%) had diabetes comprising 24 (22%) with type 2 controlled with diet, 39 (36%) with type 2 treated with oral hypoglycaemic agents, 40 (37%) with type 2 treated with insulin with or without oral hypoglycaemic agents and 5 (5%) with type 1. Diabetes was present in 82/351 (23%) medical, 7/61 (11%) psychiatric and 19/286 (7%) surgical patients. Control was ideal (BGL 3.5‐8.0 mmol/L) in 12% and modest (BGL 3.5‐8.0 mmol/L, plus at least one BGL 8.1‐12 mmol/L) in 29%, leaving 59% suboptimal (BGL not 3.5‐12 mmol/L). Severe hyperglycaemia (at least one BGL≥20 mmol/L) occurred in 12% and moderate hyperglycaemia (at least one BGL≥15 but none≥20 mmol/L) in 30%. Hypoglycaemia (at least one BGL < 3.5 mmol/L) was documented in 11%. Mean BGL was < 6 mmol/L in 5%, 6.1–8.0 mmol/L in 33%, 8.1‐10 mmol/L in 23%, and > 10 mmol/L in 39%. Suboptimal control was identified in 100% of type 1, 87% of type 2 treated with insulin with or without oral hypoglycaemic agents, 58% of type 2 treated with oral hypoglycaemic agents, and 9% of type 2 controlled with diet (p < 0.0001). There was no difference in glycaemic control between patients from medical, psychiatric or surgical units. Insulin‐to‐test orders, used in 34 (31%) patients, were judged as ‘safe’ in only 9 (26%) patients. Conclusion: Management of inpatients with diabetes requires improvement, supporting the need for guideline development and continuing education.

Outcomes for general medical inpatients with diabetes mellitus and new hyperglycaemia

“…The prevalence of diabetes in Australian tertiary referral hospitals has been estimated to be 23% 12 . The prevalence of newly diagnosed hyperglycaemia and its associations has not been documented in Australian hospitals.…”

Routine glucose assessment in the emergency department for detecting unrecognised diabetes: a cluster randomised trial

“…As many as one‐quarter of hospitalised adult patients are known to have diabetes . Hyperglycaemia in patients without previously diagnosed diabetes is also common; for instance, 12% of 2030 patients in one American hospital had newly identified hyperglycaemia .…”