Endocrine Abstracts

Hyperglycaemia in hospitalised patients is associated with increased mortality and healthcare costs. American Diabetes Association (ADA) recommends a target glucose of 7.8-10 mmol/l/lfor insulin treated inpatients. The Insulin Management Round (IMR) is a unique specialty-led intervention at our hospital with daily insulin prescribing and titration on a dedicated insulin kardex for inpatients referred via the electronic record system. This audit retrospectively reviewed all IMR referrals (excluding critical care) over six random days to analyse referral characteristics and assess glycaemic control (classified as stable if glucose 5-10 mmol/l/l; unstable if >10 mmol/l/l). Of 253 IMR cases evaluated, diabetes types included type 2 (72.7%), type 1 (15.8%), CF related (5.1%), steroid-induced (4.7%), type 3c (1.6%). Baseline control was suboptimal in 40.1% (HbA1c 54–74 mmol/l/mol) and poor in 23.7% (≥75 mmol/l/mol). Insulin regimen comprised multiple daily injections (38.3%), pre-mixed insulin (36.8%), sliding scale (13.8%), and basal insulin ± sliding scale (11.1%). Complex cases represented 43.5%, mainly due to erratic patterns (49.1%) or steroids (17.3%), followed by enteral feeding (12.7%), transplant (9.1%), dialysis (9.1%) and parenteral nutrition (2.7%). Complex patients were distributed across surgical (54.5%) and medical (45.5%) wards. Diabetes consultations were requested in 43.5% overall, rising to 74.5% in complex cases; diabetes nurse reviews were sought in 43.9%. Stable glycaemic control within ADA targets was achieved in 55.7% (n = 141). While >50% of IMR-managed patients achieved recommended targets, a significant proportion had inadequate baseline control and were deemed complex. Enhanced electronic flagging of at-risk patients and prompt diabetes consultation may further improve inpatient glycaemic outcomes.