Background: Hypoglycaemia is a common complication during inpatient management of patients with diabetes who are treated with insulin and/or insulin secretagogues. The results of published studies are, however, influenced by inclusion of patients who have been admitted with a primary diagnosis of hypoglycaemia or who have acute conditions associated with glycaemic instability and an increased risk of hypoglycaemia.
Objective: The aim of the present study was to conduct an audit of the incidence and associates of hypoglycaemic events in patients who had been transferred for ongoing management on two general medical and two geriatric wards at Fremantle Hospital after initial stabilisation of their acute illness in an Acute Medical Unit.
Methods: Between end-March and mid-May 2017 (a 7-week period), all episodes of hypoglycaemia (bedside blood glucose level (BGL) ≤3.9 mmol/L) categorised as i) non-severe with the ability to self-treat or ii) severe requiring second party assistance1 were ascertained from regular audit of the inpatient nursing notes and observation charts.
Results: During 5,453 patient-days of observation (61% on the geriatric wards), 14 inpatients with hypoglycaemia were identified. They were of mean±SD age 74±12 years, 50% were male, 79% Anglo-Celt and all had type 2 diabetes. There were 29 hypoglycaemic episodes in total (range 2.4-3.9 mmol/L), representing between 1 and 7 (2±2) per patient, 10 (34.5%) were severe and 11 (38%) occurred during sleep. During the 7-week observation period, the inpatients with hypoglycaemia accounted for 192 bed-days or 3.5% of capacity.
Conclusions: Approximately 1 in 30 of all general medical/geriatric inpatients will experience hypoglycaemia after stabilisation of their acute illness. Most will have more than one episode and one in three episodes will require second party assistance. The results of this continuing audit suggest that hypoglycaemia is common and often severe in adult inpatients with diabetes after stabilisation of their presenting illness.