Endocrine Abstracts

Introduction: Diabetes Mellitus affects 14 in 100 adults aged 18 or over. In the acute setting, 18 in 100 people occupying a bed have diabetes. As poor glycaemic control is linked to adverse health outcomes, our aim was to identify the proportion of patients admitted to acute medicine with a most-recent HbA1c > 60mmol/mol as a marker of sub-optimal glycaemic control that might benefit from point-of-contact diabetes specialist nurse (DSN) intervention. Secondary areas of interest were to check if serum creatinine, albumin creatinine ratio (ACR), HbA1c and lipids were checked in the preceding 12 months.

Methods: Data on 48 patients with diabetes admitted to acute medicine was collected prospectively at point of presentation.

Results: Recent median HbA1c was 52.5mmol/mol. 31% of patients had recent HbA1c > 60mmol/mol, with a median age of 73.5 yrs. 38% of patients were on oral hypoglycaemic agents, 29% were taking insulin only, and 6% were taking both insulin and OHA. In the 12 months before presentation, 54%, 92% and 81% had their ACR, HbA1c and lipids investigated respectively. Inpatient DSN activity for a calendar month showed that 173 patients (362 total episodes) were reviewed in acute medicine. Intervention by the DSN team resulted in expedited discharges / admissions avoidance in 33.5 % of patients.

Conclusion: Advancing age is associated with sub-optimal glycaemic control. Whilst glycaemic control in this age group is not expected to be tight, controlling hyperglycaemia is important to reduce diabetes hyperosmolar symptoms to reduce polyuria, nocturia and the risk of falls. Community monitoring of HbA1c and lipids were satisfactory for the majority but ACR checks were suboptimal. The inpatient DSN team play a vital role in optimising glycaemic control in acute medical admissions and their role could potentially be extended to opportunistic intervention for non-glycaemic process of care measures to improve health outcomes.