title: Hyperglycemia management in patients admitted to internal medicine in Spain: A point-prevalence survey examining adequacy of glycemic control and guideline adherence.
abstract: OBJECTIVE
  Despite the increasing prevalence of hospitalized diabetic patients, there are few studies that evaluate the glycemic control and the rate of adherence to clinical practice guidelines for glucose monitoring and management in the hospital setting.
  
  
  METHODS
  Crossover study using one-day surveys of all inpatients admitted to internal medicine wards from voluntary participating hospitals across Spain. Retrospective review of medical records was used to identify patients with hyperglycemia, causes for hospitalization, patients' demographic characteristics, appropriateness of glycemic monitoring and treatment during hospitalization.
  
  
  RESULTS
  Among 5439 hospitalized patients studied there were 1000 (18.4%) with hyperglycemia in 111 participating hospitals. Patients mean age was 76.0±8.5 years (51.6% male). On admission, 91% had known diabetes (disease duration of 10.9±8.5 years), 5% had unknown diabetes and 4% had stress hyperglycemia. The comorbidity index (Charslon score) was 4 (interquartile range: 2 to 6) and 31% showed a high level of disability (Rankin scale). Main infringement in the process of care included lack of a recent HbA1c value (43.7%), use of sliding scale insulin therapy (20.7%), use of oral antidiabetic agents (8.9%), and less than three bedside point-of-care (POC) blood glucose test per day (17%). Glycemic target pre-meal and bedtime were achieved in 47% to 79.5% of POC. The rates of hypoglycemia (<70 mg/dL and <50mg/dL) were 10.3% and 2.4%, respectively.
  
  
  CONCLUSIONS
  Our results suggest that there is an important gap between the clinical guidelines and both the management and the grade of glycemic control of diabetic inpatients.
authors.affiliation: Department of Internal Medicine, Hospital Marina Baixa, Villajoyosa, Alicante, Spain. Electronic address: ena_jav@gva.es.
authors.forename: Javier
authors.initials: J
authors.lastname: Ena
authors.affiliation: Department of Internal Medicine, Hospital Regional Universitario de Malaga, Málaga, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Gómez-Huelgas
authors.affiliation: Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Romero-Sánchez
authors.affiliation: Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
authors.forename: Antonio Zapatero
authors.initials: AZ
authors.lastname: Gaviria
authors.affiliation: Department of Internal Medicine, Hospital Universitario Virgen del Rocio, Sevilla, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Calzada-Valle
authors.affiliation: Department of Internal Medicine, Hospital Universitario Virgen del Rocio, Sevilla, Spain.
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Varela-Aguilar
authors.affiliation: Department of Internal Medicine, Hospital Universitario Virgen del Rocio, Sevilla, Spain.
authors.forename: Maria de la Luz
authors.initials: Mde L
authors.lastname: Calero-Bernal
authors.affiliation: Department of Internal Medicine, Hospital Universitario Virgen del Rocio, Sevilla, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Garcia-Contreras
authors.affiliation: Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Berdún-Chéliz
authors.affiliation: Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
authors.forename: Borja
authors.initials: B
authors.lastname: Gracia-Tello
authors.affiliation: Department of Internal Medicine, Hospital Infanta Margarita, Madrid, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Mejias-Real
authors.affiliation: Department of Internal Medicine, Hospital San Juan de Dios del Aljarafe, Sevilla, Spain.
authors.forename: Concepción
authors.initials: C
authors.lastname: González-Becerra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004032:Diet / Q000706:statistics & numerical data; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007388:Internal Medicine / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: Diabetes mellitus; Guideline; Hospitalization; Hypoglycemic agents; Insulin; Point-prevalence