Diabetes Ward Management—Room for Improvement

Background: Diabetes control frequently deteriorates during hospitalisation and changes to management are often required. Aim: To evaluate the prevalence, diabetes type, admitting unit and glycaemic control of hospital inpatients with diabetes mellitus and the use of insulin‐to‐test orders (sliding scales). Method: Information on demographics, glycaemic control and insulin‐to‐test orders were collected for inpatients with diabetes mellitus by surveying medical records, 48 hours of blood glucose levels (BGLs) and drug charts. Results: Of the 698 inpatients, 108 (15%) had diabetes comprising 24 (22%) with type 2 controlled with diet, 39 (36%) with type 2 treated with oral hypoglycaemic agents, 40 (37%) with type 2 treated with insulin with or without oral hypoglycaemic agents and 5 (5%) with type 1. Diabetes was present in 82/351 (23%) medical, 7/61 (11%) psychiatric and 19/286 (7%) surgical patients. Control was ideal (BGL 3.5‐8.0 mmol/L) in 12% and modest (BGL 3.5‐8.0 mmol/L, plus at least one BGL 8.1‐12 mmol/L) in 29%, leaving 59% suboptimal (BGL not 3.5‐12 mmol/L). Severe hyperglycaemia (at least one BGL≥20 mmol/L) occurred in 12% and moderate hyperglycaemia (at least one BGL≥15 but none≥20 mmol/L) in 30%. Hypoglycaemia (at least one BGL < 3.5 mmol/L) was documented in 11%. Mean BGL was < 6 mmol/L in 5%, 6.1–8.0 mmol/L in 33%, 8.1‐10 mmol/L in 23%, and > 10 mmol/L in 39%. Suboptimal control was identified in 100% of type 1, 87% of type 2 treated with insulin with or without oral hypoglycaemic agents, 58% of type 2 treated with oral hypoglycaemic agents, and 9% of type 2 controlled with diet (p < 0.0001). There was no difference in glycaemic control between patients from medical, psychiatric or surgical units. Insulin‐to‐test orders, used in 34 (31%) patients, were judged as ‘safe’ in only 9 (26%) patients. Conclusion: Management of inpatients with diabetes requires improvement, supporting the need for guideline development and continuing education.