Diabetes care in the hospital: is there clinical inertia?
BACKGROUND
Effective control of hospital glucose improves outcomes, but little is known about hospital management of diabetes.


OBJECTIVE
Assess hospital-based diabetes care delivery.


METHODS
Retrospective chart review.


METHODS
Academic teaching hospital.


METHODS
Inpatients with a discharge diagnosis of diabetes or hyperglycemia were selected from electronic records. A random sample (5%, n = 90) was selected for chart review.


METHODS
We determined the percentage of patients with diabetes or hyperglycemia documented in admission, daily progress, and discharge notes. We determined the proportion of cases with glucose levels documented in daily progress notes and with changes in hyperglycemia therapy recorded. The frequency of hypoglycemic and hyperglycemic events was also determined.


RESULTS
A diabetes diagnosis was recorded at admission in 96% of patients with preexisting disease, but daily progress notes mentioned diabetes in only 62% of cases and 60% of discharge notes; just 20% of discharges indicated a plan for diabetes follow-up. Most patients (86%) had bedside glucose measurements ordered, but progress notes tracked values for only 53%, and only 52% had a documented assessment of glucose severity. Hypoglycemic events were rare (11% of patients had at least one bedside glucose < 70 mg/dL), but hyperglycemia was common (71% of cases had at least one bedside glucose > 200 mg/dL). Despite the frequency of hyperglycemia, only 34% of patients had their therapy changed.


CONCLUSIONS
Practitioners were often aware of diabetes at admission, but the problem was often overlooked during hospitalization. The low rate of documentation and therapeutic change suggests the need for interventions to improve provider awareness and enhance inpatient diabetes care.
Knecht
Laura A D
LA
Division of Endocrinology, Mayo Clinic, Scottsdale, Arizona, USA.
Gauthier
Susanne M
SM
Castro
Janna C
JC
Schmidt
Ronald E
RE
Whitaker
Michael D
MD
Zimmerman
Richard S
RS
Mishark
Kenneth J
KJ
Cook
Curtiss B
CB
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003920:Diabetes Mellitus / Q000097:blood* / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000628:therapy; D007902:Length of Stay / Q000639:trends; D008297:Male; D012189:Retrospective Studies
D001786:Blood Glucose