Kheng Yong Ong1, Yu Heng Kwan2, Hooi Ching Tay3, Doreen Su-Yin Tan3, Joanne Yeh Chang4. 1. Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore ; Specialist Outpatient Clinics, Department of Pharmacy, Singapore General Hospital, Singapore. 2. Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore ; Duke-NUS Graduate Medical School Singapore, Singapore. 3. Department of Pharmacy, Khoo Teck Puat Hospital, Singapore. 4. Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore.
Abstract
INTRODUCTION: As the effectiveness of intensive glycaemic control is unclear and recommended glycaemic targets are inconsistent, this study aimed to ascertain the prevalence of dysglycaemia among hospitalised patients with diabetes mellitus in an Asian population and evaluate the current standards of inpatient glycaemic control. METHODS: A retrospective observational study was conducted at a secondary hospital. Point-of-care blood glucose (BG) values, demographic data, medical history, glycaemic therapy and clinical characteristics were recorded. Dysglycaemia prevalence was calculated as proportions of BG-monitored days with at least one reading exceeding the cut points of 8, 10 and 15 mmol/L for hyperglycaemia, and below the cut point of 4 mmol/L for hypoglycaemia. RESULTS: Among the 288 patients recruited, hyperglycaemia was highly prevalent (90.3%, 81.3% and 47.6% for the respective cut points), while hypoglycaemia was the least prevalent (18.8%). Dysglycaemic patients were more likely than normoglycaemic patients to have poorer glycated haemoglobin (HbA1c) levels (8.4% ± 2.6% vs. 7.3% ± 1.9%; p = 0.002 for BG > 10 mmol/L) and longer lengths of stay (10.1 ± 8.2 days vs. 6.8 ± 4.7 days; p = 0.007 for BG < 4 mmol/L). Hyperglycaemia was more prevalent in patients on more intensive treatment regimens, such as basal-bolus combination therapy and the use of both insulin and oral hypoglycaemic agents (100.0% and 96.0%, respectively; p < 0.001 for BG > 10 mmol/L). CONCLUSION: Inpatient glycaemic control is suboptimal. Factors (e.g. type of treatment regimen, discipline and baseline HbA1c) associated with greater prevalence of dysglycaemia should be given due consideration in patient management.
INTRODUCTION: As the effectiveness of intensive glycaemic control is unclear and recommended glycaemic targets are inconsistent, this study aimed to ascertain the prevalence of dysglycaemia among hospitalised patients with diabetes mellitus in an Asian population and evaluate the current standards of inpatient glycaemic control. METHODS: A retrospective observational study was conducted at a secondary hospital. Point-of-care blood glucose (BG) values, demographic data, medical history, glycaemic therapy and clinical characteristics were recorded. Dysglycaemia prevalence was calculated as proportions of BG-monitored days with at least one reading exceeding the cut points of 8, 10 and 15 mmol/L for hyperglycaemia, and below the cut point of 4 mmol/L for hypoglycaemia. RESULTS: Among the 288 patients recruited, hyperglycaemia was highly prevalent (90.3%, 81.3% and 47.6% for the respective cut points), while hypoglycaemia was the least prevalent (18.8%). Dysglycaemic patients were more likely than normoglycaemic patients to have poorer glycated haemoglobin (HbA1c) levels (8.4% ± 2.6% vs. 7.3% ± 1.9%; p = 0.002 for BG > 10 mmol/L) and longer lengths of stay (10.1 ± 8.2 days vs. 6.8 ± 4.7 days; p = 0.007 for BG < 4 mmol/L). Hyperglycaemia was more prevalent in patients on more intensive treatment regimens, such as basal-bolus combination therapy and the use of both insulin and oral hypoglycaemic agents (100.0% and 96.0%, respectively; p < 0.001 for BG > 10 mmol/L). CONCLUSION: Inpatient glycaemic control is suboptimal. Factors (e.g. type of treatment regimen, discipline and baseline HbA1c) associated with greater prevalence of dysglycaemia should be given due consideration in patient management.
Authors: Stephen Clement; Susan S Braithwaite; Michelle F Magee; Andrew Ahmann; Elizabeth P Smith; Rebecca G Schafer; Irl B Hirsch; Irl B Hirsh Journal: Diabetes Care Date: 2004-02 Impact factor: 19.112
Authors: Alexander Turchin; Michael E Matheny; Maria Shubina; James V Scanlon; Bonnie Greenwood; Merri L Pendergrass Journal: Diabetes Care Date: 2009-07 Impact factor: 19.112
Authors: Jeffrey L Carson; Peter M Scholz; Anita Y Chen; Eric D Peterson; Jeffrey Gold; Stephen H Schneider Journal: J Am Coll Cardiol Date: 2002-08-07 Impact factor: 24.094
Authors: Suellen M Curkendall; Jaime L Natoli; Charles M Alexander; Brian H Nathanson; Tracy Haidar; Robert W Dubois Journal: Endocr Pract Date: 2009 May-Jun Impact factor: 3.443
Authors: Etie S Moghissi; Mary T Korytkowski; Monica DiNardo; Daniel Einhorn; Richard Hellman; Irl B Hirsch; Silvio E Inzucchi; Faramarz Ismail-Beigi; M Sue Kirkman; Guillermo E Umpierrez Journal: Diabetes Care Date: 2009-05-08 Impact factor: 19.112