Background: Currently 30% of hospital inpatients have diabetes and this proportion is increasing. The management of inpatients with diabetes is challenging and hypoglycaemia is a serious event that can negatively affect the course of a patient’s illness and consume significant resources.

Aim: To determine the frequency and factors associated with hypoglycaemic episodes experienced by inpatients with diabetes.

Methods: A case control study was conducted of patients in the endocrinology/ renal ward and two general medicine wards. Cases (n=36) were patients who experienced hypoglyceamia. Controls (n=34) were matched to cases by age, sex and duration of diabetes. Clinical information and dietary intake in the preceding 24 hours was compared.

Results: The mean age of the cases and controls were 72.8 and 73.7 years respectively. The proportions of males were 59% and 56% in the case and control groups, respectively. Mean duration of diabetes was 18 years in both groups. Of the 36 cases, 77% experienced more than one episode of hypoglycaemia. Odds ratios for the development of hypoglycemia according to observed variables (odds ratio; p value) were: missing meals (2.23; 0.18) requiring a texture modified diet (1.78; 0.45), reduced oral intake (1.79; 0.31), requiring assistance to eat (2.05; 0.21), change in diabetes medications (2.09; 0.13), insulin treatment (2.76; 0.05), sliding scale insulin ( 0.55; 0.21), sulphonylureal medication (1.18; 0.74), cognitive impairment (1.33; 0.63). The calorie intake in both groups was similar. The carbohydrate intake in the case group was reduced however this was not statistically significant ( p= 0.4).

Conclusion: Hypoglycaemia occurs frequently in the inpatient population with diabetes. This relatively small but intensive trial identified a number of factors which can potentially contribute to increased hypoglycemia risk. Several of these factors could be modified with targeted quality improvement activities and organizational change. This audit will inform service improvement.