The in-hospital pharmacological management of patients with diabetes has recently been identified by the National Diabetes Inpatient Audit as a key safety issue. Over 30% of inpatient drug charts surveyed in the 2013 audit had at least 1 diabetes medication error in the preceding week. Patients with a diabetes medication error on their drug chart were also twice as likely to have one or more hypoglycaemic episodes during their hospital stay.
A paper by Browne et al. in 2000 revealed important gaps in health professionals and patients knowledge of oral hypoglycaemic agents. New classes of anti-hyperglycaemic agents have since made the management of type 2 diabetes increasingly complex.
Our study evaluated the current knowledge of oral hypoglycaemic agents and insulin amongst healthcare professionals and final year medical students in a regional teaching hospital. 57 junior doctors, 19 staff nurses and 19 medical students were assessed using an anonymous questionnaire.
Results revealed poor knowledge of the mechanisms of action, timing of administration, main side effects and cautions of traditional hypoglycaemic agents amongst both healthcare professionals and students. Under 33% of respondents, for example, knew the main cautions of common sulphonylureas. Knowledge of newer hypoglycaemic agents such as GLP1 agonist, DPPV inhibitors and SGLT2 inhibitors was significantly worse than older classes (eg biguanides and sulphonylureas). Additionally, there were gaps in knowledge relating to the management of insulin sliding scales and of the pharmacology of insulin.
Unawareness of issues central to the safe prescribing and administration of diabetes medication has implications for both patient safety and patient education. This study highlights the need for greater emphasis on teaching healthcare professionals about management of type 2 diabetes at a both an undergraduate level and in the workplace.