Type 2 diabetes is a prevalent condition, affecting 30% of hospital inpatients at any one time [1]. In inpatients the most appropriate indicator of medium-term glycaemic control is the HbA1c [2]. The Royal Melbourne Hospital (RMH) is currently instituting a proactive inpatient diabetes service (IDS) to enhance diabetes care in the hospital. The aim of this study was to evaluate discharge prescription of oral hypoglycaemic medications (OHM) in general medical inpatients against existing guidelines [2].
Methods:
Discharge summaries for all 2,335 general medical separations at the RMH for the calendar year 2015 were screened to identify patients with type 2 diabetes. Information on demographics, co-morbidities, medications, and biochemistry was collected and analysed.
Results:
831 (35.6%) patients with diagnosed type 2 diabetes were identified. Of these 465 patients were not receiving insulin and formed the study population. The inpatient cohort had a median age of 78 years, male proportion 51%, and median modified Charlson Comorbidity Index of 2.
At the time of admission 330 were receiving OHMs and 135 were managed with diet and lifestyle. Only 213 (45.2%) had a documented HbA1c within the last 3 months. Of the 69 patients with an HbA1c >7.0%, 27 (39.1%) (including all of the patients with HbA1c >9.0%) had intensification of their glycaemic therapy by the time of hospital discharge.
Conclusion:
General medicine inpatients with type 2 diabetes on OHMs may not undergo adequate assessment of their glycaemic control. A minority of diabetes inpatients using OHM with suboptimal glycaemia had their diabetes medication intensified.