Objectives: Patients with diabetes have longer and more complicated hospital stays than non-diabetic patients. The 2001 UK National Service Framework (NSF) recommends that the management of these patients should be supplemented by diabetes nurse specialists (DNS). This study aimed to audit the implementation of this recommendation, how it can be targeted and the impact it has on patient care.
Study design and setting: One month long cross-sectional study of 55 inpatients with diabetes, aged 4192 years at a district general hospital.
Results: Patients with diabetes occupied 20% of hospital beds (national average 6% to 16%). Only 18% of patients were referred to DNS. The majority of DNS referrals were related to poor glycaemic control and protracted hospital stays (P<0.01). Change of anti-diabetic medications was significantly (P=0.015) more common in diabetic patients who were admitted for diabetes related complications (73%) than diabetic patients who were admitted for other medical problems (35%). Significantly more patients who were reviewed by DNS had their anti-diabetic medications changed (80%) compared to those who were not reviewed (38%) (P=0.03). Six months after hospital admission, the levels of HbA1C dropped by 20% in patients with an inpatient review by DNS compared to a gain of 4% in those without (P<0.01).
Conclusions: Utilisation of DNS service did not meet the NSF for diabetes target, in part due to lack of awareness and availability of the service, as well as the absence of clear criteria for referral. Where utilised, DNS impacted positively on diabetes inpatient care, including appropriate change of anti-diabetic medication and improved long-term glycaemic control. DNS services should be made available for all diabetic inpatients with diabetes-related admissions and poor glycaemic control.