title: Diabetes care in the hospital: is there clinical inertia?
abstract: 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.
authors.affiliation: Division of Endocrinology, Mayo Clinic, Scottsdale, Arizona, USA.
authors.forename: Laura A D
authors.initials: LA
authors.lastname: Knecht
authors.forename: Susanne M
authors.initials: SM
authors.lastname: Gauthier
authors.forename: Janna C
authors.initials: JC
authors.lastname: Castro
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Schmidt
authors.forename: Michael D
authors.initials: MD
authors.lastname: Whitaker
authors.forename: Richard S
authors.initials: RS
authors.lastname: Zimmerman
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mishark
authors.forename: Curtiss B
authors.initials: CB
authors.lastname: Cook
mesh_terms: 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
chemical_list: D001786:Blood Glucose