Managed by Antonio Secchi.
Inpatient hypoglycaemia is common and associated with adverse outcomes. There is often increased vigilance of hypoglycaemia in inpatients with type 1 diabetes (T1DM) compared to type 2 diabetes (T2DM). We aimed to investigate this apparent discrepancy, utilising the time to repeat (TTR) capillary blood glucose (CBG) measurement as a surrogate for engagement with guidelines stating that CBG should be rechecked following intervention within 15 min of an initial CBG of <4 mmol/L.
This is an observational study of inpatient CBG data from 8 hospitals over a 7-year period. A national diabetes registry allowed identification of individual’s diagnosis and diabetes therapy. For each initial (index) CBG, the TTR for individuals with T2DM—on insulin or sulphonylurea—was compared with the TTR for individuals with T1DM, using a t test for significance performed on log(TTR). The median TTR was plotted for each group per index CBG.
In total, 1480,335 CBG measurements were obtained. A total of 26,664 were <4 mmol/L. The TTR in T2DM individuals on sulphonylurea was significantly greater than in T1DM individuals where index CBG was ≥2.3 mmol/L (except index CBG 2.6 mmol/L). For T2DM patients receiving insulin significance exists for index CBGs of ≥3.2 mmol/L.
This analysis suggests that quality of care of hypoglycaemia varies according to diagnosis and medication. The group with the highest TTR (T2DM sulphonylurea treated) are possibly the clinical group in whom hypoglycaemia is most concerning. These data therefore suggest a need for education and raising awareness within the inpatient nursing staff.
International Hypoglycaemia Study Group (2015) Minimizing hypoglycemia in diabetes. Diabetes Care 38:1583–1591 CrossRef
UK Hypoglycaemia Study Group (2007) Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia 50:1140–1147 CrossRef
Health And Social Care (2016) National Diabetes Inpatient Audit 2015. In: National Diabetes Inpatient Audit. http://www.hscic.gov.uk/diabetesinpatientaudit. Accessed 16 Jun 2016
American Diabetes Association (2001) Living with diabetes. Hypoglycemia (low blood glucose). In: American Diabetes Association. http://www.diabetes.org/. Accessed 16 Jun 2016
Jones GC, Perry CG, Monaghan A et al (2015) Capillary blood glucose monitoring, inpatient hypoglycaemia and quality of care. Br J Diabetes 15:24–26 CrossRef
Hanefeld M, Duetting E, Bramlage P (2013) Cardiac implications of hypoglycaemia in patients with diabetes—a systematic review. Cardiovasc Diabetol 12:1–11 CrossRef
- Is all hypoglycaemia treated as equal? An observational study of how the type of diabetes and treatment prescribed prior to admission influences quality of treatment of inpatient hypoglycaemia
Gregory C. Jones
Christopher A. R. Sainsbury
- Springer Milan
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
e.Med Kampagnen-Visual, Mail Icon II