For the management of in-patient hyperglycaemia, it is generally assumed that standard practice is inferior to practice by specialist, endocrine, services. The latter is thought to provide better glycaemic control through greater knowledge and improved clinical practices around glycaemic management1-3, yet the evidence attesting to this is typically based on formal clinical trials of novel protocols rather than from “real world” clinical practice.
A retrospective audit has been conducted of 23 patients (to date) referred to the Liverpool Hospital endocrinology inpatient consultation team (ET) for management of dysglycaemia. The mean days to consultation, mean daily blood glucose levels (BGL) and clinical action taken prior and post ET consultation were assessed.
Results (mean ± SD) are preliminary. Mean days prior to endocrinology consultation was 5.6 ± 5.3 days. BGLs prior to ET consultation was 13.4 ± 4.4 mmol/L; post consultation was 11.1 ± 3.8 mmol/L, with a significant improvement in the mean average BGL of 2.3 mmol/L (p=0.005). The percentage of BGLs that were hyperglycaemic (>14 mmol/L) was 48% prior to, and 26% post ET consultation with a significant reduction in hyperglycaemia events post consultation by 23% (p=0.001). There was no significant difference in hypoglycaemia. The most common actions taken by the non-ET treating team for hyperglycaemia prior to consultation was use of insulin dextrose infusions and stat non-regular insulin doses. Post ET consultation, the most common actions were commencement and titration of doses of regular insulin. Data collection is ongoing and more results will be presented at meeting.
In the “real world”, inpatient glycaemia control benefits from specialist endocrinology consultation with improvements in mean BGLs and reductions in the frequency of hyperglycaemia. While there are a variety of clinical actions available to improve glycaemia, actions taken by the ET are significantly more effective.