A multi-centre qualitative study of experiences of managing diabetes mellitus among adults while hospitalised

One in six hospital beds across England is occupied by someone with diabetes. While guidance on inpatient diabetes care is available, national audit data demonstrate that people still experience significant and avoidable diabetes-related harms. This study is unique in exploring how people with diabetes admitted to hospital for any medical reason experienced diabetes care from admission to discharge. It is part of a bigger project aiming to develop and test a Patient Reported Experience Measure for inpatients with diabetes.

A qualitative approach was used to explore experiences of inpatient diabetes care. Twenty-seven participants with type 1 or type 2 diabetes, hospitalised for any reason, were recruited using purposive sampling across four acute NHS Trusts in the South of England. Data collected in semi-structured interviews were analysed with reflexive thematic analysis.

In diabetes care, the emphasis is on supporting people with self management of their diabetes. The inpatient care setting compromises this by limiting self management behaviours. These restrictions may apply to those who want to and can be actively involved in their diabetes care and may contribute to less effective diabetes management and poorer outcomes. For some participants in this study, diabetes self management was discouraged in three ways. First, their knowledge of their diabetes and willingness to self-manage were not taken into account on admission or in planning their inpatient diabetes care. Second, their involvement in decisions about their ongoing diabetes care was limited. Third, their needs related to diabetes management were not met because of the lack of flexibility in hospital practices and schedules.

Inpatient care is not always conducive to diabetes self management. Understanding the patient experience in the inpatient setting related to self management is important in reducing harm to patients while they are in hospital. Our findings emphasise the importance of involving people with diabetes in planning and managing their care while hospitalised. Further work needs to be done to ensure that the knowledge, involvement and flexibility of care of people with diabetes are incorporated into an inpatient setting.