Inpatient Blood Glucose Management of Diabetic Patients in a Large Secondary Hospital

Abstract

Background: Diabetes has become a major health problem worldwide, as well as in South Africa. This as well as the chronicity of the disease relate to an increasing burden on health care facilities and an increasing number of hospital admissions of patients with diabetes. Admissions are mostly related to diabetes itself, but the frequency of admissions for problems unrelated to diabetes are increasing as the prevalence of diabetes is increasing in the population. Proper inpatient glycaemic management is important to improve patient outcome and to reduce the risk of inpatient complications. The objective of this study was to evaluate the current practices in the care of diabetic inpatients as well as to assess the glycaemic control that is achieved during hospitalisation. Methods: An audit of clinical hospital records of adult diabetic patients admitted to Kalafong Hospital, a large secondary hospital in South Africa, was done. All patients admitted who had type 1 or type 2 diabetes before admission or who were newly diagnosed on admission or in hospital were included, irrespective of the discipline to which the patient was admitted. All patient admissions in the eight-month period preceding the initiation of the audit were included. Results: The hospital records of 164 diabetic patients were audited. With regard to glucose monitoring, 60.8% of patients had irregular and erratic glucose monitoring, 37.2% had regular (either four- or six-hourly) monitoring and only 2% were monitored in relation to meals. Of the 164 patients, 160 were not fasting, 27 patients were treated with an insulin sliding scale at some stage during admission, and in 14 (52%) of the patients on sliding scales the scale was used inappropriately. Most, 48 (30.4%) hospital inpatients with diabetes were treated with oral agents only; 29 (18.4%) with oral agents plus once daily NPH insulin and 17 (10.8%) with twice-daily mixed insulin. Only three patients (1.9%) received supplemental insulin to their regimen. The glycaemic control treatment schedule was appropriate in only 19.5% of cases. Conclusions: Based on the research findings, the monitoring and management of blood glucose in patients with diabetes during hospitalisation is currently inadequate. This calls for an educational intervention for doctors and nurses working with diabetic inpatients as well as the introduction of a blood glucose management protocol.