Background: Efforts to decrease hyperglycaemia in hospital often lead to greater incidence of hypoglycaemia. We propose the concept of Adverse Glycaemic Day ([AGD]: a patient-day with any capillary blood glucose [BG] <4.0 or >15.0 mmol/L), as a measure of safe diabetes care in hospital, given both hypo- and hyperglycaemia are undesirable. We studied the incidence & associations of AGDs in the 10 week baseline period of the Randomised trial of Proactive Inpatient Diabetes Service (RAPIDS: ACTRN12616000265471).
Methods: Consecutive inpatients with diabetes or new-onset hyperglycaemia (random BG ≥11.1 mmol/L without known diabetes) were recruited. Networked glucose meters were used to record capillary BGs from admission until discharge, or day 14 for long-stayers.
Results: We studied 441 patients (87% type 2 diabetes; 29% insulin-treated; A1c: 7.5±1.7%). AGDs occurred in 736 (26%) of 2810 patient-days. Of all AGDs, 83% were due to hyperglycaemia (>15.0 mmol/L), 14% due to hypoglycaemia (<4.0 mmol/L), and 3% due to both. Half (49%) of patients had no AGD while 25% of patients had ≥3 AGDs, accounting for two thirds of all observed AGDs. On multivariable analysis, AGDs were independently associated with multiple clinical factors including older age, greater comorbidities, insulin-requiring diabetes, higher HbA1c and glucocorticoid treatment.
Conclusion: Adverse glycaemic days were common in inpatients with diabetes and occurred at an approximate rate of 250 per 1000 patient-days. We propose AGD incidence is used to evaluate the performance and safety of hospital glycaemic management programs.