Audit of glycaemic control and management in patients with diabetes in a cardiac unit — ASN Events
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Audit of glycaemic control and management in patients with diabetes in a cardiac unit (#298)

M.L. Ong 1 , S. Zoungas 2 3 , H.J. Teede 2 3 , J.L.A. Wong 2 3
  1. Monash Heart, Monash Medical Centre, Clayton, VIC, Australia
  2. Diabetes Clinical Services, Southern Health, Dandenong, VIC, Australia
  3. Monash Applied Research Stream, School of Public Health and Preventive Medicine, Clayton, VIC, Australia

Background: Hyperglycaemia has been associated with increased morbidity and mortality in hospitalized patients.123  Recently published guidelines have highlighted the need for good glycaemic control  to reduce morbidity and mortality in non-critically ill hospitalised patients.45   The Australian Diabetes Society  (ADS) have advocated maintaining blood glucose levels between 5-10mmol/L  and recommended the use of basal, prandial and supplemental insulin to maintain glycaemic control in the inpatient setting. Here we assess contemporary inpatient glycaemic management in a high risk population with diabetes in a large tertiary referral health service.

Method: A prospective audit of diabetics admitted to the Coronary Care Unit at Monash Medical Centre, Southern Health from April to May 2012. Glycaemic control and glycaemic management of patients was assessed.

Results: Fifty patients were studied. The mean age was 66 ± 12 years. All patients had type 2 diabetes with a mean disease duration of 8 ± 4 years. The majority of patients were admitted for acute coronary syndrome (52%) and cardiac failure (19%). Mean HbA1c was 7.6 ± 1.6%.  Diabetes management pre-hospitalization consisted of oral agents alone (56%), insulin alone (22%), insulin and oral agents (14%) and diet alone (8%). While hospitalized, 75% of the patients were treated with their pre-hospital regimen, 19% received additional supplemental insulin and 6% received twice daily premixed insulin. Blood sugar monitoring was frequent with an average of 5 readings a day.  76% of all readings were maintained below 10mmol/l. 29% of the patients experienced a hypoglycaemic episode however most episodes were mild (70%). 60% of patients had recurrent hypoglycaemia.

Conclusions: The majority of patients achieved satisfactory glycaemic control defined as blood glucose below 10mmol/L.  This was achieved with the continuation of usual diabetes treatment.  some with use of supplemental insulin. Rates of hypoglycaemia were however high.  Randomized trials are required to compare different glucose management regimens that minimize risk of hypoglycaemia.

  1. Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87:978-982.
  2. Kosiborod M, Inzucchi SE, Goyal A, et al. The relationship between spontaneous and iatrogenic hypoglycemia and mortality in patients hospitalized with acute myocardial infarction [abstract]. Circulation. 2008;118(suppl):S1109.
  3. Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet. 2000;355:773-778.
  4. Umpierrez GE. Hellman R. Korytkowski MT. Kosiborod M. Maynard GA. Montori VM. Seley JJ. Van den Berghe G. Endocrine Society.Management of hyperglycemia in hospitalized patients in non-critical care settings: an endocrine society clinical practice guidelin
  5. ADS Australian Diabetes Society Guidelines for routine glucose control in hospital, in press, 2012.