title: Is all hypoglycaemia treated as equal? An observational study of how the type of diabetes and treatment prescribed prior to admission influences quality of treatment of inpatient hypoglycaemia.
abstract: OBJECTIVE
  Inpatient hypoglycaemia is common and associated with adverse outcomes. There is often increased vigilance of hypoglycaemia in inpatients with type 1 diabetes (T1DM) compared to type 2 diabetes (T2DM). We aimed to investigate this apparent discrepancy, utilising the time to repeat (TTR) capillary blood glucose (CBG) measurement as a surrogate for engagement with guidelines stating that CBG should be rechecked following intervention within 15 min of an initial CBG of <4 mmol/L.
  
  
  METHODS
  This is an observational study of inpatient CBG data from 8 hospitals over a 7-year period. A national diabetes registry allowed identification of individual's diagnosis and diabetes therapy. For each initial (index) CBG, the TTR for individuals with T2DM-on insulin or sulphonylurea-was compared with the TTR for individuals with T1DM, using a t test for significance performed on log(TTR). The median TTR was plotted for each group per index CBG.
  
  
  RESULTS
  In total, 1480,335 CBG measurements were obtained. A total of 26,664 were <4 mmol/L. The TTR in T2DM individuals on sulphonylurea was significantly greater than in T1DM individuals where index CBG was ≥2.3 mmol/L (except index CBG 2.6 mmol/L). For T2DM patients receiving insulin significance exists for index CBGs of ≥3.2 mmol/L.
  
  
  CONCLUSIONS
  This analysis suggests that quality of care of hypoglycaemia varies according to diagnosis and medication. The group with the highest TTR (T2DM sulphonylurea treated) are possibly the clinical group in whom hypoglycaemia is most concerning. These data therefore suggest a need for education and raising awareness within the inpatient nursing staff.
authors.affiliation: Diabetes Department, Gartnavel General Hospital, Glasgow, G11 0YN, UK. g.jones3@nhs.net.
authors.forename: Gregory C
authors.identifier: http://orcid.org/0000-0002-8847-3122
authors.initials: GC
authors.lastname: Jones
authors.affiliation: Diabetes Department, Gartnavel General Hospital, Glasgow, G11 0YN, UK.
authors.forename: Jansher
authors.initials: J
authors.lastname: Khan
authors.affiliation: Diabetes Department, Gartnavel General Hospital, Glasgow, G11 0YN, UK.
authors.forename: Christopher A R
authors.initials: CAR
authors.lastname: Sainsbury
mesh_terms: D000328:Adult; D000368:Aged; D001774:Blood Chemical Analysis / Q000379:methods; D001786:Blood Glucose / Q000032:analysis; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D007003:Hypoglycemia / Q000145:classification* / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007297:Inpatients; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D013453:Sulfonylurea Compounds / Q000009:adverse effects
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds
keywords: Diabetes; Hypoglycaemia; Inpatient; Insulin; Quality of care; Sulphonylurea