Review of Inpatient Hyperglycaemia in Non-Critically Ill Patients with Type 2 Diabetes Mellitus or Stress Hyperglycaemia — ASN Events
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Review of Inpatient Hyperglycaemia in Non-Critically Ill Patients with Type 2 Diabetes Mellitus or Stress Hyperglycaemia (#25)

Loki Johnk 1 , Gerry Fegan 2
  1. Department of Intensive Care Medicine, Mackay Base Hospital, Mackay, QLD, Australia
  2. Department of Diabetes and Endocrinology, Fremantle Hospital, Fremantle, WA, Australia

Background: Diabetes is present in 10-40% of hospital admissions and is associated with increased morbidity and mortality1. Hyperglycaemia independent of known diabetes is also associated with poorer outcomes2. Inpatient glucose lowering has shown improved outcomes, yet exact glycaemic targets remain uncertain and hypoglycaemia should be avoided3. Increasingly, "sliding-scale" approaches are being replaced by more physiologically appropriate "basal-bolus" insulin; however, there is lack of standardized protocols4.

Aims: To evaluate current management of inpatient hyperglycaemia in a tertiary hospital.

Methods: Observational study of inpatients with documented type 2 diabetes, random blood glucose levels (BGL) > 11.1 mmol/L or fasting BGL > 7.8 mmol/L from 10th to 21st January, 2011. Exclusion criteria: Critical care setting and type 1 diabetes. 2007 AACE/ADA guidelines used to define glucose values5. Fremantle Hospital is a 24-hour, acute-care, 450-bed public teaching hospital in Western Australia. Current inpatient guidelines only exist for IV insulin use. 104 patients were identified. Data collected included patient demographics, measured HbA1C, blood glucose levels, episodes of hypo- (BGL < 4) and hyperglycaemia (BGL > 10) and interventions. Approved by Clinical Governance Department.

Results: During the 10 day study period 104 patients were identified and 88 studied in detail. On admission 83% of patients were on diabetes medication. Mean HbA1C: 8.2%

Results shown in tables 1-4.

Table 1: Patient Demographics and Specialty Location

187-Table%201.jpg 

Table 2: Prevalence of Hyperglycaemia BGL > 10 and Hypoglycaemia BGL < 4

188-Table%202.jpg

Table 3: Management Strategies for Hyperglycaemia

186-Table%203.jpg

Medical teams were 4.5 times more likely to modify existing treatment than surgical teams (95% CI: 1.35-14.57, p=0.014).

Table 4: Inaction following episodes of hyperglycaemia

189-Table%204.jpg

Conclusion: This study has shown that inpatient hyperglycaemia is common and managed by a variety of strategies. Sliding scale insulin use is still prevalent and hypoglycaemia remains a concern. This highlights the need for guidelines aimed at improving glycaemic control in hospitalized patients.

  1. Clement, S., et al. Management of Diabetes and Hyperglycaemia in Hospitals. Diabetes Care 2004; 27(2): 553-579.
  2. McAlister, F., et al. The Relation between Hyperglycemia and Outcomes in 2471 Patients Admitted to the Hospital with Community-Acquired Pneumonia. Diabetes Care 2005; 28(4): 810-5.
  3. Finfer, S., et al. Intensive vs. Conventional Glucose Control in Critically Ill Patients. New England Journal of Medicine 2009; 360: 1283-97.
  4. Umpierrez, G., et al. Randomized study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients with Type 2 Diabetes (RABBIT2 Trial). Diabetes Care 2007; 30(9): 2181-6.
  5. AACE Diabetes Mellitus Clinical Practice Guidelines Taskforce. AACE Diabetes Mellitus Guidelines. Diabetes Management in the Hospital Setting. Endocrine Practice 2007; 13(1): 59-63.