Introduction and aim:
Inpatient hypoglycaemia is a serious complication of insulin therapy. Following hypoglycaemia, review of glucose-lowering therapy is often the responsibility of junior medical staff, with specialist diabetes team involvement determined by local referral pathways and treating team discretion. The aim of this study was to review the quality of hypoglycaemia management and follow-up care at our hospital and to identify potential interventions to minimise recurrent hypoglycaemia.
Method:
Inpatients with hypoglycaemia (point-of-care glucose < 4.0mmol/L), admitted to a medical or surgical ward at Concord Repatriation General Hospital over a 10-week period (8 January – 17 March 2020) were prospectively identified using Live Glucose, an EMR-based glucose informatics system. We collected patient and admission data, and quality measures relating to hypoglycaemia treatment, medical review, recurrence, and rates of inpatient diabetes team referral.
Results:
We identified 211 episodes of hypoglycaemia among 81 patients (Type 2 diabetes 78%; insulin therapy on admission 70%; mean ± SD age, 72.6 ± 15 years), over 86 separate admissions (medical 64%, surgical 36%). Half of these patients had recurrent hypoglycaemia within their admission. Following hypoglycaemia, most had appropriate documentation of acute treatment (92%) and adequate glucose monitoring over the next 48 hours (97%), but only 42% had immediate medical review. A specific management plan addressing hypoglycaemia (review of insulin doses, diabetes team referral, etc.) was not documented in a third of cases. In patients with recurrent hypoglycaemia, only 63% were referred to endocrinology, and only 61% had hypoglycaemia documented as a complication in discharge paperwork.
Conclusion:
There is significant room for improvement in hypoglycaemia management and follow-up care. Despite clear best practice standards at the local, district and state level, specialist diabetes services are underutilised, particularly following recurrent hypoglycaemia. EMR-based solutions such as Live Glucose would allow early proactive review by specialist teams following hypoglycaemia.