Background: Admission for diabetes related illnesses are common. Diabetes management is complex and suboptimal management is recognised as causing adverse outcomes.
Aim: To quantify the frequency of dysglycaemia in hospitalised patients with diabetes and determine contributing factors.
Methods: A retrospective analysis over a 3 month period in a regional hospital identified 51 episodes where diabetes was either the primary or secondary admission diagnosis. Inpatient progress records were examined to quantify the frequency of dysglycaemia and assess its management.
Results: The population was 53% male, mean age 56 ± 21 years, with 43% diagnosed >10 years. 61% had type 2 Diabetes. 73% of subjects were Insulin treated on admission. 73% were admitted under a medical team with 19% admitted under endocrinology. In total 43% were reviewed by the Endocrinology service.
(82%) inpatients experienced at least one BGL >12mmol/l of which 27 (64%)
were suboptimally managed. The main factors identified were lack of escalation
of insulin for consistent hyperglycaemia (31%), lack of supplemental insulin
(27%) and inappropriate omission of insulin after hypoglycaemia (26%).
Ninety episodes of hypoglycaemia (BGL <4mmol/l) occurred in twenty-three (45%) subjects. Of these twenty-six episodes were severe (BGL <3mmol/l) in 7 (14%) subjects. All but one were treated appropriately.
Eighteen subjects (35%) were prescribed an Insulin infusion with a median length of 25hours (2hrs-12days) and 10 (56%) experienced management errors when transitioning to subcutaneous insulin. Other prescription and administration errors were identified in >20% of inpatients.
Twenty-two (43%) had their diabetic medication regimen changed. Only half of the population had self-management plans discussed at discharge and 43 (84%) had a follow up plan.
Conclusions: This audit identifies sub-optimal insulin adjustment as the main reason for dysglycaemia. We have identified areas for education of medical and nursing staff and would advocate early involvement of the inpatient endocrinology service.