Immediate in-patient management of hyperglycaemia--confusion rather than consensus?

In-patients with high blood glucose levels have much greater mortality and morbidity rates compared to normoglycaemic individuals hospitalized with the same condition.

To examine prospectively the glucose-lowering treatments used for patients admitted as acute medical emergencies with admission hyperglycaemia (11-17 mmol/l) under the care of non-diabetes specialist teams. Individuals with acute diabetes emergencies (e.g. diabetic ketoacidosis or HONK or glucose levels >17 mmol/l) were excluded.

Patients' notes were examined as they were admitted without any interventions from the diabetes team. Choice of treatment for their hyperglycaemia was noted and the average blood glucose level was calculated each day of admission for the first 5 days based on bedside fingerstick glucose measurements.

Seventy-three in-patients [37 men, average (SD) age 74.1(12) years] with hyperglycaemia [average 13.7(1.6) mmol/l] on admission were included. Fourteen were not known to have diabetes, three had type 1 and 56 type 2 diabetes. Glycaemic control was suboptimal and achieved values were unrelated to the mode of delivery of glucose-lowering therapies. Length of stay and death rates in hospital were greatest in the group of patients who were not previously known to have diabetes.

Untreated or under-treated hyperglycaemia was a common occurrence in patients admitted to hospital with an acute medical emergency. There may be a role for hospital-based specialist diabetes teams to take a lead in facilitating more acceptable glucose control to achieve standard 8 of the National Service Framework for Diabetes.