Previous guidelines1 recommended a glucose target of 5-10 mmol/L for inpatients. Surveys2 in a tertiary hospital in Queensland showed that 19.5% of inpatients showed diabetes, “good glycaemic control” occurred on 3.9/7 days (55%),was similar in 2011 and 2015 and 16% of inpatients were seen by the endocrine team. We studied the current situation in a regional, private hospital in Queensland
Methods:adult patients admitted to two medical and two surgical units over one month period with known diabetes, on corticosteroid therapy or admission glucose>11 mmol/L were included for analysis. Endocrinology or diabetic educator review during the inpatient stay was recorded. The percentage of glucose recordings between 5 to 10 mmol/L was calculated.
Results: From 113 patient admissions, 40 met the inclusion criteria (35%). From 40 admissions included, two patients did not receive glucose recording on admission. 14 received admission glucose recording but no subsequent glucose monitoring were on corticosteroid therapy but not known to have diabetes. In the 26 patients with complete glucose monitoring, glucose remained between 5 and 10 mmol/L in 65% of readings. 43% on surgical units did not receive glucose monitoring versus 22% on medical units. The endocrinology or diabetes educator involvement was sought in only two cases out of all 40 admission episodes (5%).
Conclusions: In this setting the burden of diabetes among acute admissions (35%) was twice that in a tertiary metro hospital but endocrine consultation occurred at a far lower frequency (5% versus 16%). Particularly amongst surgical admissions and patients receiving corticosteroids, glucose monitoring was less often carried out. However when glucose recordings were available, the glucose values recorded compared favourably (65% in range versus 55% good control days) to the tertiary hospital.More frequent referral for endocrine support of surgical and corticosteroid treated patients would appear to be a potential method for improved outcomes.