Hyperglycemia management in patients admitted to internal medicine in Spain: A point-prevalence survey examining adequacy of glycemic control and guideline adherence

• We carried out a national cross sectional study to assess the burden of hyperglycemia in patients admitted to internal medicine.
• We compared inpatient diabetes management to the standards for glucose control recommended in evidence-based guidelines.
• We observed scarce assessment of HbA1c to guide therapy at discharge
• There was high use of non recommended therapy such oral hypoglycaemic agents and sliding scale insulin.
• Inappropriate snacks between meals were used very often in the evening and at night

AimsDespite 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.ResultsAmong 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 < 50 mg/dL) were 10.3% and 2.4%, respectively.ConclusionsOur 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.