Evaluating the impact of planned ward admissions in High HbA1c patients

Sijith Radhakrishnan; Taffy Makaya

doi:10.1530/endoabs.95.P25

Introduction: NICE guidelines recommend additional support is provided to CYP with a high HbA1c. Elective hospital admissions are one option for improving glycaemic control.

Aims/objectives: To evaluate the implementation of, and impact on HbA1c of, planned admissions in CYP in our service.

Methods: All planned admissions for management of sustained high HbA1c in patients with known T1D from 01/01/2021-31/12/2022 were included for review.

Results: Patient demographic data: Eight patients were identified, three aged 3years, and 5 aged 13–17years. M:F ratio=6:2. Duration of diabetes was: 8-months to 11-years, average duration of 3-years 2-months. All 8 patients were on subcutaneous injection therapy: n=7 on MDI injections; and n=1 on Tresiba and Humulin M3. Admission HbA1cs ranged from 71 mmo/mol to >140 mmol/mol.

Table 1 Review by MDT members.
Seen by→ Seen on↓	Consultant	PDSN	Paediatric Dietitian	Clinical psychologist
Day 1	25%	100%	37.5%	50%
By Day 3	75%	100%	100%	87.5%

Table 2 HbA1c outcomes.
	HbaA1c post admission (mmol/mol)
Patient Number	0-months (Baseline)	0–3 months	3–6 months	6–12 months
Patient 1	133	66 ↓	76↑	58 ↓
Patient 2	117	46↓	54↑	66 ↑
Patient 3	109	87↓	104↑	104 ↔
Patient 4	93	78↓	89↑	86 ↔
Patient 5	71	63↓	57↓	n/a
Patient 6	>140	72↓	72↔	73 ↔
Patient 7	81	65↓	66↔	68 ↔
Patient 8	116	112↓	101↓	89 ↓
Average HbA1c	107.5	73.63 ↓	77.38↔	77.71 ↔
pValue Ave-HbA1c Delta		0–3-months: 0.013	0–6 months: 0.017	0–12 months: 0.019

Inpatient management:: Average inpatient stay was 6 days in n=8 (range 3–14 days). Review by the MDT was as follows:Table 1 Review by MDT members.Three patients had inpatient reviews by the social services team. There were no weekend diabetes MDT reviews. HBA1c and therapy outcomes: Two patients were discharged on insulin pump therapy, and n=6 had significant adjustments to their subcutaneous insulin dosage regimen. Table 2 shows HbA1c outcomes from admission upto 12-months post-admission.Table 2 HbA1c outcomes.

Discussion/conclusion: Planned admissions are useful in managing high HbA1cs, resulting in clinically and statistically significant improvements in HbA1c (>5 mmol/mol/ pValue<0.05). Overall improvement was sustained at 12 months, despite some rebound in HbA1c. Having a clear plan for the admission is helpful in organising MDT staff resources.

Endocrine Abstracts

P25