Room to improve diabetes management in hospital: Queensland study

Diabetes management in hospitalised patients would benefit from a shot in the arm, according to findings from the Queensland Inpatient Diabetes Survey (QuIDS) 2019.

Of concern, the survey found high rates of medication error, hospital-acquired harm such as hypoglycaemia and diabetic ketoacidosis, and suboptimal rates of appropriate glycaemic control particularly in patients treated with insulin.

The cross-sectional bedside audit captured management of diabetes in 850 patients from medical, surgical, mental health, high dependency or intensive care wards across 27 public hospitals in Queensland.

The audit found medication errors in 32% of patients including both prescription errors (19%) and management errors (19%). Errors were more than twice as common in patients receiving insulin than in patients receiving oral hypoglycaemic agents.

There were also low rates of achieving glycaemic targets with 59 good diabetes days per 100 patient-days.

Hypoglycaemic episodes – either moderate (74%) or severe (26%) – were identified in 9.5% of patients and diabetic ketoacidosis was identified in 8% of patients with type 1 diabetes.

The study, published in The MJA,  found 29% of patients who underwent surgery during their admission had a clearly documented perioperative diabetes management plan.

“The deficiencies in practice we found exist despite a standard insulin prescription and blood glucose monitoring form and statewide digital prescribing and glucose monitoring; both systems are linked with point-of-care decision support that provides evidence-based advice about safe prescribing of basal-bolus insulin for hospitalised patients,” the study said.

The researchers, led by Dr Peter Donovan from the Royal Brisbane and Women’s Hospital, said 14% of patients met the criteria for specialist team care, but were not seen by any diabetes specialists either medical, nursing or allied health.

“To improve inpatient diabetes care in Queensland, expanding the availability of specialist diabetes teams should be considered,” they said.

Dr Donovan, a staff specialist in internal medicine and clinical pharmacology, told the limbic that the study was the first step towards improving how patients with diabetes were managed.

“We knew that there was a problem but no-one had actually documented the particular areas of diabetes management that needed to be focussed on.”

“It wasn’t really a surprise what we found and the results are consistent with what are being found in England and Wales and in the National Diabetes Inpatient Audit.”

He said the problems were obviously complex as Queensland already had good statewide protocols for a number of aspects of diabetes care such as a statewide form for monitoring blood sugars and prescribing insulin and statewide protocol for preventing diabetic ketoacidosis.


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