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Dr. Bill's Commentaries

Dr. Bill Quick began writing at HealthCentral's diabetes website in November, 2006. These essays are reproduced at D-is-for-Diabetes with the permission of HealthCentral.

In-patient Diabetes Care Needs Improvement   (May 21, 2012)

A survey of 12,000 hospitalized diabetes patients, done in 2011, has just been released. I won’t mention where the survey was done until later in this essay. The survey is done annually, and the results are compared to prior years. Some improvements were noted in 2011 compared to 2010: for instance, the survey noted that there has been an improvement in medication errors and more appropriate use of intravenous insulin infusions.

But many of the findings are, to my thinking, unacceptable. Here is a recap of some of these; I have paraphrased some, but others are exact quotes from the report:

  • Of those patients requiring diabetes team referral just over half were actually seen.
  • Diabetes consultant availability has decreased.
  • Under one-third of sites have no specific diabetes specialist nurses.
  • A significant reduction in specialist inpatient dietetic time allocated to diabetes was noted compared to the year before.
  • Podiatry inpatient provision is worsening: 30.9% of sites report no podiatry provision (26.8% in 2010).
  • 32 per cent of patients (3,430) experienced at least one medication error in the previous seven days of their hospital stay.
  • More than 17 per cent (600) of patients with medication errors had a severe hypoglycemic attack while in hospital.
  • 68 patients developed diabetic ketoacidosis (DKA) during their hospital stay, implying that their insulin programs were grossly inadequate.
  • 28.1 per cent of patients who responded to the patient experience questionnaire stated that they had not been able to take control of their own diabetes while in hospital as much as they would have liked to.
  • 14.1 per cent of patients stated that they were not able to test their own blood glucose levels but would have liked to (17.7 per cent of patients reported they were able to test their own blood glucose levels while hospitalized).
  • 9.8 per cent of patients on insulin were not permitted to self-administer their insulin but would have liked to (70.5 per cent had been permitted, and and 19.8 per cent of patients stated that they did not want to self administer.)
  • The audit shows that 14.5 per cent of patients reported that the hospital did not provide the right type of food to manage their diabetes. 13.5 per cent of patients stated that they brought food into the hospital to meet their dietary needs.
  • The choice of meals was always or almost always suitable for the majority of patients (70.5 per cent), however 22.8 per cent of patients reported that the meal choice was only sometimes suitable and 6.7 per cent stated that it was rarely or never suitable.

How can improvements be made? As the Foreword to the report states, it’s partially up to diabetes teams, which have been “committed to providing the evidence, benchmarking themselves and introducing new ways of working to improve care. Indeed, in addition to the changes made after the audit in 2009, in this last year 123 sites have implemented additional changes in practice to improve care.” But additional resources are also needed: there has been “little change in diabetes staffing with inadequate provision of inpatient specialist diabetes care at many sites.”

Another thought: Activated diabetes patients and their families must demand better diabetes care: they should insist on meeting with the inpatient diabetes nurse specialist ASAP (ideally before admission!) and together develop a diabetes care plan for their physician's review and approval.

Let me jump back to the question from the beginning of this essay: where was the survey done? It’s from the National Diabetes Inpatient Audit 2011, which was done  in England and Wales.

I wonder about the findings if similar surveys were done in the United States (and/or other countries). Sorry to say, despite the unflagging efforts of individual Certified Diabetes Educators and organizations such as the American Association of Diabetes Educators, I’d anticipate that the survey results would be comparable just about anywhere.

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