Endocrine Abstracts

Inpatient hypoglycaemia is common and associated with adverse outcome during admission and post discharge. We investigated management of hypoglycaemia using the time to repeat (TTR) capillary blood glucose (CBG) measurement as a surrogate for engagement with clinical guidelines.

Methods: Inpatient CBG data from 8 hospitals over a 7 y period were analysed. Primary care prescribing information was available, and admissions were associated with insulin or SU therapies if a prescription was identified during the 4 months prior to admission. During an admission, the time interval between each CBG measurement was calculated, and analysed per initial (index) CBG value. For each index CBG, the TTR for those individuals with T2DM – insulin or SU treated – was compared with the TTR for those individuals with T1DM, using a t test performed on log(TTR) to test significance.

Results: T1DM: 4304 individuals with 406490 CBG values. T2DM/insulin therapy: 5163 IDs with 484067 CBGs. T2DM/SU therapy: 13015 IDs with 589778 CBGs.

Hypoglycaemic (<4 mmol/l) CBGs – T1DM: 26664. T2DM/insulin: 23591. T2DM/SU: 30344

Median (IQR) TTR for index CBGs in the range 1–3.9 mmol/l: T1DM 53 (26–112) mins; T2DM/insulin 64 (30–147) mins; T2DM/SU 97 (40–292) mins.

The TTR in the T2DM/SU was significantly greater than T1DM where the index CBG is >=2.3 (except index CBG 2.6). For the T2DM/insulin significance exists for index CBGs of >=3.2.

Conclusions: Guidelines suggest identical action for hypoglycaemic index CBGs regardless of clinical context. This analysis suggests that quality of care varies according to the underlying diagnosis and prescribed drugs. TTR decreases as the index CBG decreases as clinically expected. The group with the highest TTR (T2DM SU treated) are possibly the clinical group in whom the risks associated with hypoglycaemia are greatest. These data therefore suggest a need for education and raising awareness within ward staff.ain