Javier Ena1, Ricardo Gómez-Huelgas2, Marta Romero-Sánchez3, Antonio Zapatero Gaviria3, Ana Calzada-Valle4, Jose Manuel Varela-Aguilar4, Maria de la Luz Calero-Bernal4, Rosa Garcia-Contreras4, Miguel Angel Berdún-Chéliz5, Borja Gracia-Tello6, Inmaculada Mejias-Real7, Concepción González-Becerra8. 1. Department of Internal Medicine, Hospital Marina Baixa, Villajoyosa, Alicante, Spain. Electronic address: ena_jav@gva.es. 2. Department of Internal Medicine, Hospital Regional Universitario de Malaga, Málaga, Spain. 3. Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain. 4. Department of Internal Medicine, Hospital Universitario Virgen del Rocio, Sevilla, Spain. 5. Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain. 6. Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain. 7. Department of Internal Medicine, Hospital Infanta Margarita, Madrid, Spain. 8. Department of Internal Medicine, Hospital San Juan de Dios del Aljarafe, Sevilla, Spain.
Abstract
AIMS: Despite the increasing prevalence of hospitalized diabetic patients, there are few studies that evaluate the glycemic control and the rate of adherence to clinical practice guidelines for glucose monitoring and management in the hospital setting. METHODS: Crossover study using one-day surveys of all inpatients admitted to internal medicine wards from voluntary participating hospitals across Spain. Retrospective review of medical records was used to identify patients with hyperglycemia, causes for hospitalization, patients' demographic characteristics, appropriateness of glycemic monitoring and treatment during hospitalization. RESULTS: Among 5439 hospitalized patients studied there were 1000 (18.4%) with hyperglycemia in 111 participating hospitals. Patients mean age was 76.0±8.5 years (51.6% male). On admission, 91% had known diabetes (disease duration of 10.9±8.5 years), 5% had unknown diabetes and 4% had stress hyperglycemia. The comorbidity index (Charslon score) was 4 (interquartile range: 2 to 6) and 31% showed a high level of disability (Rankin scale). Main infringement in the process of care included lack of a recent HbA1c value (43.7%), use of sliding scale insulin therapy (20.7%), use of oral antidiabetic agents (8.9%), and less than three bedside point-of-care (POC) blood glucose test per day (17%). Glycemic target pre-meal and bedtime were achieved in 47% to 79.5% of POC. The rates of hypoglycemia (<70 mg/dL and <50mg/dL) were 10.3% and 2.4%, respectively. CONCLUSIONS: Our results suggest that there is an important gap between the clinical guidelines and both the management and the grade of glycemic control of diabetic inpatients.
AIMS: Despite the increasing prevalence of hospitalized diabeticpatients, there are few studies that evaluate the glycemic control and the rate of adherence to clinical practice guidelines for glucose monitoring and management in the hospital setting. METHODS: Crossover study using one-day surveys of all inpatients admitted to internal medicine wards from voluntary participating hospitals across Spain. Retrospective review of medical records was used to identify patients with hyperglycemia, causes for hospitalization, patients' demographic characteristics, appropriateness of glycemic monitoring and treatment during hospitalization. RESULTS: Among 5439 hospitalized patients studied there were 1000 (18.4%) with hyperglycemia in 111 participating hospitals. Patients mean age was 76.0±8.5 years (51.6% male). On admission, 91% had known diabetes (disease duration of 10.9±8.5 years), 5% had unknown diabetes and 4% had stress hyperglycemia. The comorbidity index (Charslon score) was 4 (interquartile range: 2 to 6) and 31% showed a high level of disability (Rankin scale). Main infringement in the process of care included lack of a recent HbA1c value (43.7%), use of sliding scale insulin therapy (20.7%), use of oral antidiabetic agents (8.9%), and less than three bedside point-of-care (POC) blood glucose test per day (17%). Glycemic target pre-meal and bedtime were achieved in 47% to 79.5% of POC. The rates of hypoglycemia (<70 mg/dL and <50mg/dL) were 10.3% and 2.4%, respectively. CONCLUSIONS: Our results suggest that there is an important gap between the clinical guidelines and both the management and the grade of glycemic control of diabetic inpatients.
Authors: María Paula Russo; Santiago Nicolas Marquez Fosser; Cristina María Elizondo; Diego Hernán Giunta; Nora Angélica Fuentes; María Florencia Grande-Ratti Journal: Rev Diabet Stud Date: 2021-11-01