Background:
The United Kingdom (UK) has implemented a National Diabetes Inpatient Audit (NaDIA)1 since 2009 with the aim of improving diabetes care in hospitals. The NaDIA has not been reported from an Australian hospital.
Aim:
To characterise and benchmark against the UK an Australian tertiary hospital’s management of inpatient diabetes.
Methods:
At the Princess Alexandra Hospital, Brisbane, a prospective audit utilising the NaDIA questionnaire of all inpatients (excluding the emergency department and intensive care) identified to have diabetes was conducted on 2 single days in 2011 and 2015.
Results:
In 2011, 130 patients (19.5% of all inpatients) were identified with diabetes and 110 (16.5%) in 2015. Minimal differences were identified between the cohorts hence the data were combined.
Compared with the UK 2011 NaDIA, the Australian diabetes inpatients were less likely to be an emergency admission (72.6% vs 84.5%). There was a similar proportion of patients with T1DM (5.1% vs 6.7%). More patients with T2DM were on insulin (43.5% vs 34.4%).
There was a high rate of medication errors in the Australian cohort (48% vs. 32.4%). 16.3% of inpatients were seen by the endocrine team versus 30.3% in the UK.
The assessment of glycaemic control defined as ‘Good diabetes days’ (appropriate testing frequency, no hypoglycaemia and only one reading >11mmol/L) occurred on 3.9/7 days vs. 4.0/7 in the UK. Rates of hypoglycaemia were lower in the Australian cohort (overall 17.9% vs. 23.4%; major (<3mmol/l) 4.6% vs 10.6%). Major hypoglycaemia was more likely if reported to have had a medication error (26.7 vs. 10.6%, p<0.001).
Conclusion:
This Australian tertiary hospital is experiencing a similar burden of inpatient diabetes as that reported in the UK. The rate of hypoglycaemia and medication errors is alarming. The hospital has become “digital” and opportunities to facilitate safer insulin prescribing are required.