The prevalence of diabetes in hospitalized patients is between 11-25% (ADS, 2012), with both diabetes and hyperglycaemia independently associated with worse outcomes (Clement et al, 2004). Clinical audit at Fremantle Hospital in 2011 showed high rates of inpatient hyperglycaemia, along with an apparent reluctance for doctors to adjust insulin and oral hypoglycaemic medication (Johnk, 2011). Since then, several interventions have occurred, including increased endocrinologist availability and a pilot trial of the national insulin chart.
Re-audit rates of in-patient hyperglycaemia at Fremantle Hospital, review management strategies and compare with previous audit data.
10-day study period. Inclusion criteria: type 2 diabetes, random blood sugar levels (BSL) > 11.1 mmol/L (bedside or laboratory measurement) or fasting BSL > 7.8 mmol/L. Exclusion criteria: type 1 diabetes, intensive care and palliated patients. Data collected included patient demographics, HbA1C, bedside BSLs, episodes of hypo- (BSL<4) and hyperglycaemia (BSL>10) and interventions.
55 patients were identified, mean HbA1c 8.5% and mean length of stay 7 days. Previous audit n=88, mean HbA1c 8.2%. 90% of patients had at least one hyperglycaemic episode during their hospital admission; mean number of elevated glucose levels per patient n=13. Multiple elevations of glucose were required to result in clinical action; 92% of patients with ≥7 hyperglycaemic episodes having medication orders altered, but only 17% of patients with 1-6 hyperglycaemic episodes. Basal bolus insulin was identified as the main management strategy in 36% of patients. Hypoglycaemia occurred in 7%. Compared with data collected in 2011, there did not appear to be any significant improvement in the prevalence or management of hyperglycaemia over time.
Clinical audit data has not shown any significant improvement in in-patient hyperglycaemia despite several interventions. Future improvements likely depend on an appropriate systematic health-wide policy approach in conjunction with structured education sessions for hospital staff.