Background: Diabetes is increasing in hospitalized patients (1) and its management is complex with suboptimal glucose control, medication errors and patient complaints being common. Inpatient diabetes is associated with adverse outcomes including life threatening metabolic complications (diabetic ketoacidosis, hyper- and hypoglycaemia), infection, increased length of stay and increased mortality.

Aim: To assess inpatient diabetes management specifically in relation to diabetes medication errors and resultant glucose control. 

Methods: We retrospectively audited the medical records of 85 inpatients of the Royal Melbourne Hospital during September 2011. We examined the patients’ medical history including progress notes, glycaemic records and medication chart aiming to assess the adequacy of oral hypoglycaemic and insulin diabetes medication prescription and administration in addition to frequency of adverse effects including hypoglycemia [capillary blood glucose level (BGL) <4mmol/l], hyperglycemia [BGL>10mmol/l).

Results: The 85 consecutive inpatients with diabetes (mean age 75 ± 24 years, 51% males) were admitted, under multiple medical and surgical units for an average 10.5 day length of stay. Only 9.4% of patients were reviewed by the inpatient Diabetes and Endocrinology service. Fifty-eight (68%) inpatients had at least one error associated with the prescription or administration of an oral hypoglycaemic medication and eighteen (21%) at least one error in the prescription or administration of insulin (Table 1). Sixty (71%) inpatients did not have optimal BGL monitoring (QID testing pre-meals and nocte). Forty-five (53%) inpatients experienced a peak BGL of >14 mmol/l with 26% experiencing a peak BGL of >18mmol/l. Twenty inpatients (23.5%) experienced at least one episode of hypoglycaemia during the admission.

Conclusions: The management of diabetes medications in hospital inpatients is suboptimal and a contributor to hyper and hypoglycaemia. This audit identifies areas for improvement in diabetes medication prescription and administration to enhance patient safety.

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