Endocrine Abstracts

Background: Suboptimal glycaemic control in hospital inpatients is related to poor clinical outcomes and longer hospital stay. The aims of this study were to document the prevalence and severity of hypo- and hyperglycaemia in medical inpatients and to evaluate aspects of patient management and staff proficiency regarding glucose management.

Methods: We performed a retrospective review of 21 381 capillary blood glucose results in 1496 unique patients on 26 inpatient wards during April 2013. We applied four audit standards (proportion achieving normo-glycaemia; appropriate diabetes team referral; re-checking of hypoglycaemia; proportion with correct patient identifier) to assess/rank ward performance.

Results: There was a large range in the proportion of inpatients with hypo- and hyperglycaemia between wards that was not readily explained by case mix (Hypoglycaemia: mild (≤4.0 mmol/l), 1–18%; moderate (<3.0 mmol/l), 0–13%; severe (<2.2 mmol/l), 0–13%; Hyperglycaemia: mild (>10 mmol/l), 2–45%; moderate (>20 mmol/l), 0–19%; severe (>28 mmol/l), 0–8%). Overall, 9% of all inpatients had at least one blood glucose value ≤4 mmol/l and only 25% of patients were appropriately referred to the diabetes team following episodes of severe hypo/hyperglycaemia. Of the 774 hypoglycaemic blood glucose values, only 9% were re-tested within 15 min and only 85% of all tests were accompanied by a valid patient identifier.

Conclusion: The wide variation in ward performance and suboptimal glucose control overall has highlighted a need for intensive ward-based diabetes education focusing on some underperforming wards. We will improve visibility of glucose results for clinicians and make future ward performance data freely available within the trust to stimulate improvements in performance.