The in-patient management of persons with diabetes means many things to different people.  From a medical perspective, the focus has been on the relationship between glycaemic control and patient outcomes.  The initial DIGAMI study suggested that improved glycaemic control improved the long term outcomes of patients presenting with acute coronary ischaemia and hyperglycaemia.  Studies performed in ICU suggested better outcomes including mortality in patients whose BGLs were normalised with intravenous insulin.  However DIGAMI 2 did not confirm the initial findings and subsequent ICU studies also failed to confirm the benefit of short term tight control in ICU.

The management of diabetes in hospital has become a focus of the Australian Diabetes Society who are developing a series of guidelines on the management of patients in various clinical situations.  A more comprehensive series of guidelines is available from the American Diabetes Society.

The Queensland Clinical Diabetes Network has developed protocols for the standardisation of management of ketoacidosis as well as developing a standardised approach to dealing with patients admitted to hospital using insulin infusion pumps.

At a basic level, hospital management of diabetes begins with the insulin ordering form.  Many years ago, we attempted to change the form to force improved management practices.  After 61 versions, the form has an established role in improving the care of patients with diabetes in Queensland and is now being considered for a national pilot. 

The inpatient care of diabetes continues to be a major problem and improved decision support tools should lead to better outcomes for patients.  However, many entrenched clinical practices continue to make change difficult.