Introduction and Aim:
Auditing and benchmarking of hospital glucometric outcomes has been advocated by Kyi and colleagues1 from Melbourne to help improve the quality of inpatient diabetes care. Inpatient hypoglycaemia is a common adverse event among patients on insulin therapy. Its incidence is underestimated by DRG coding data. Live Glucose is an EMR-based solution that provides real-time informatics from point-of-care glucose data, allowing identification of all inpatient hypo- and hyperglycaemia. The aim of this study was to assess rates of inpatient hypoglycaemia at our hospital.
Method:
We used Live Glucose to prospectively identify all cases of hypoglycaemia (point-of-care glucose <4.0 mmol/L) among medical and surgical inpatients at Concord Repatriation General Hospital over a 10-week period (8 January–17 March 2020). Consecutive low glucose values were counted as part of the same hypoglycaemic episode.
Results:
During the study period, there were 711 admissions for 643 patients with diabetes (mean age 72.0years), totalling 5,996 patient-days. We identified 81 patients (mean age 72.6 years) with at least one episode of hypoglycaemia over 86 separate admissions. There were 211 unique episodes of hypoglycaemia during the study period, corresponding to 188 patient-days with hypoglycaemia. Most patients were on insulin therapy at admission (70%) and had type 2 diabetes (78%). Recurrent
hypoglycaemia was observed in 50% of patients; level 2 hypoglycaemia (<3.0 mmol/L) in 47%. Hypoglycaemia incidence was comparable to Royal Melbourne Hospital for all hypoglycaemia (3.1% vs. 4.6%, patient-days) and level 2 hypoglycaemia (1.1% vs. 1.3%, patient-days) 1, and lower than international benchmarks.
Conclusion:
While rates of hypoglycaemia at our hospital are similar to local benchmarks, the incidence of recurrent hypoglycaemia is concerning. Live Glucose provides real-time glucose informatics and may enhance the ability of inpatient diabetes teams to identify, intervene, and prevent cases of recurrent hypoglycaemia