Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Introduction

Patients with diabetes are hospitalised more frequently than those without. Hyperglycaemia is associated with increased adverse outcomes and length of stay (LOS). Insulin is among the top 5 high-risk medications used in hospitals.

Objectives

To compare: (i) Diabetes prevalence at a Sydney Teaching Hospital between 2013, 2014 and 2016.      (ii) Inpatient diabetes management to plan service delivery. 

Methods

We conducted 3 single-day point prevalence surveys of all inpatient records in November 2013, 2014 and 2016. Twelve teams completed an 18-item survey on all admitted patients (n=394 2013, n=381 2014, n=368 2016). Diabetes diagnosis was ascertained if: (i) diabetes documented in medical record; or (ii) patient prescribed diabetes medication/s; or (iii) fasting glucose ≥7mmol/L; or (iv) random glucose ≥11.1mmol/L; or (v) HbA1c ≥6.5%.

Results

Diabetes prevalence was 20-25%. In 2016, highest prevalence was found in Heart/Lung Transplant (59%) and Heart Failure (50%). As outlined in the Table, the majority were male and had type 2 diabetes. Half received subcutaneous insulin during admission and many experienced at least one insulin prescription/administration error. In the 7-days preceding the survey, hyperglycaemia occurred on >10 occasions in one quarter of patients and hypoglycaemia occurred on ≥ 1 occasion in 11-13% of patients. Of the diabetes patients who met referral criteria, only half-to-two-thirds were referred.

Conclusions

One-quarter of hospital patients have diabetes. Half are treated with insulin during admission. Insulin errors are common. Diabetes inpatient teams are underutilised.