Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2014

Review of inpatient management of dysglycaemia in Diabetes Mellitus by general and specialist services in a south-west Sydney tertiary hospital. (#350)

Lili Yuen 1 2 , Hamish D Russell 1 , Carmen KY Wong 1 , Vincent W Wong 1 2 , Namson S Lau 1 2
  1. Diabetes & Endocrine Service, Liverpool Hospital, Liverpool, NSW, Australia
  2. LIVE DIAB CRU, Ingham Institute, University of New South Wales, Liverpool, NSW, Australia


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.

  1. Shah BR1, Hux JE, Laupacis A, Zinman B, van Walraven C. Clinical inertia in response to inadequate glycemic control: do specialists differ from primary care physicians? Diabetes Care 2005;28(3):600-6.
  2. Shah BR1, Hux JE, Laupacis A, Mdcm BZ, Austin PC, van Walraven C. Diabetic patients with prior specialist care have better glycaemic control than those with prior primary care. J Eval Clin Pract 2005;11(6):568-75.
  3. Zgibor JC1, Songer TJ, Kelsey SF, Weissfeld J, Drash AL, Becker D, Orchard TJ. The association of diabetes specialist care with health care practices and glycemic control in patients with type 1 diabetes: a cross-sectional analysis from the Pittsburgh epidemiology of diabetes complications study. Diabetes Care 2000;23(4):472-6.