Hospital inpatients with diabetes are increasing in prevalence. Anecdotal experience suggests hypoglycemia and hyperglycemia in hospital is frequent and and suboptimal diabetes care a problem. We aimed to identify the frequency of suboptimal glycaemic control (adverse glycaemic events) and the response by clinical staff.
In this hospital-based prospective clinical audit detailed information was obtained regarding patient demographics, medical conditions, glycaemic control and diabetes management in 216 diabetes patients admitted over a 3 month period in 2014 (mean age 69y, 74% medical, 26% surgical). Patient data were intensively audited during the first 72 hours of admission. The population consisted of consecutive diabetes inpatients across medical and surgical units. An adverse glycaemic event was defined as ‘hypoglycaemia’ (BG <4.0mmol/L), or ‘acute hyperglycaemia’ (two measures of a BG >10.0mmol/L on any given day). Acute hyperglycaemia also included subgroups of ‘persistent hyperglycaemia’ (two days of acute hyperglycaemia) and critical hyperglycaemia (BG >20.0mmol/L).
In the first 72 hours of admission, acute hyperglycemia occurred in 70% (n=152) of inpatients and 50% (n=152) had at least one glucose reading >15mmol/l. Persistent hyperglycemia occurred in 51% (n=110) and critical hyperglycaemia in 15% (n=33) of inpatients. For patients experiencing acute hyperglycaemia there was evidence of nurse-initiated escalation for assessment by a medical team in 39% and medical escalation for assistance by the endocrinology service in 29%. Hypoglycemia occurred in 17% (n=36) and severe hypoglycaemia (BG <3.0mmol/L) in 5% (n=10) of inpatients. For patients experiencing hypoglycaemia there was evidence of nurse-initiated escalation for assessment by a medical team in 42%.
Adverse glycaemic events are very common in the first 72 hours of hospital admission in diabetes inpatients with inadequate escalation for medical assessment evident. Escalation pathways for adverse glycaemic events need to be developed to improve glycaemic control early in the admission of diabetes inpatients.