Hyperglycemia management in patients admitted to internal medicine in Spain: A point-prevalence survey examining adequacy of glycemic control and guideline adherence

Ena, Javier; Gómez‐Huelgas, Ricardo; Romero-Sánchez, M.; Gaviria, A. Zapatero; Calzada-Valle, Ana; Varela-Aguilar, J.M.; Bernal, María de la Luz Calero; García-Contreras, Rigoberto; Berdún-Chéliz, Miguel Angel; Gracia-Tello, Borja; Mejias-Real, Inmaculada; González-Becerra, C.

doi:10.1016/j.ejim.2015.04.020

Cited by 34 publications

(14 citation statements)

References 25 publications

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“…However, the beneficial effects of better glycemic control in patients hospitalized in internal medicine wards are not clearly established and contribute to the efforts to achieve a better glycemic control in this setting. According to Ena and colleagues, there is an important gap between the clinical guidelines and both the management and the grade of glycemic control of diabetic subjects hospitalized in Spanish internal medicine wards [ 6 ]. Contrasting data are available about association between hyperglycemia at admission and main outcomes in subjects hospitalized in internal medicine wards.…”

Section: Introductionmentioning

confidence: 99%

Hyperglycemia at admission, comorbidities, and in-hospital mortality in elderly patients hospitalized in internal medicine wards: data from the RePoSI Registry

Corrao

Nobili

Natoli³

et al. 2021

Acta Diabetol

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Aims The association between hyperglycemia at hospital admission and relevant short- and long-term outcomes in elderly population is known. We assessed the effects on mortality of hyperglycemia, disability, and multimorbidity at admission in internal medicine ward in patients aged ≥ 65 years. Methods Data were collected from an active register of 102 internal medicine and geriatric wards in Italy (RePoSi project). Patients were recruited during four index weeks of a year. Socio-demographic data, reason for hospitalization, diagnoses, treatment, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), renal function, functional (Barthel Index), and cognitive status (Short Blessed Test) and mood disorders (Geriatric Depression Scale) were recorded. Mortality rates were assessed in hospital 3 and 12 months after discharge. Results Of the 4714 elderly patients hospitalized, 361 had a glycemia level ≥ 250 mg/dL at admission. Compared to subjects with lower glycemia level, patients with glycemia ≥ 250 mg/dL showed higher rates of male sex, smoke and class III obesity. These patients had a significantly lower Barthel Index (p = 0.0249), higher CIRS-SI and CIRS-CI scores (p = 0.0025 and p = 0.0013, respectively), and took more drugs. In-hospital mortality rate was 9.2% and 5.1% in subjects with glycemia ≥ 250 and < 250 mg/dL, respectively (p = 0.0010). Regression analysis showed a strong association between in-hospital death and glycemia ≥ 250 mg/dL (OR 2.07; [95% CI 1.34–3.19]), Barthel Index ≤ 40 (3.28[2.44–4.42]), CIRS-SI (1.87[1.27–2.77]), and male sex (1.54[1.16–2.03]). Conclusions The stronger predictors of in-hospital mortality for older patients admitted in general wards were glycemia level ≥ 250 mg/dL, Barthel Index ≤ 40, CIRS-SI, and male sex.

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Section: Introductionmentioning

confidence: 99%

Hyperglycemia at admission, comorbidities, and in-hospital mortality in elderly patients hospitalized in internal medicine wards: data from the RePoSI Registry

Corrao

Nobili

Natoli³

et al. 2021

Acta Diabetol

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“…The adherence of real world clinical practice to guidelines regarding in‐hospital diabetes management is reported to be rather poor. A Spanish survey involving 1000 patients admitted to IMU wards in 111 hospitals across Spain with hyperglycaemia/DM—who were comparable for age, gender, duration of disease and mean HbA 1c to our population—showed a low adherence to the standards of diabetes care, starting with major gaps of hyperglycaemia/diabetes indicators in the medical records 22 . In that study only IMU wards were included and a raw, unstructured list of indicators was used without exploring the potential relationship with glucose control intermediate phenotypes and with clinical outcomes during admission.…”

Section: Discussionmentioning

confidence: 76%

“…Over one‐quarter of hospitalized individuals have diabetes 2 . Despite the large and increasing prevalence of patients with diabetes requiring hospitalization and the robust evidence that there exist a range of in‐hospital glucose levels, which is strongly associated to better clinical outcomes, only a very few studies have investigated the flow of clinical milestones of diabetes care as a pre‐requisite to achieve better glucose control and, possibly, better clinical outcomes during hospital admissions 22 . This might be partly owed to lack of evaluation tools to assess quality of diabetes care in hospitalized patients.…”

Section: Discussionmentioning

confidence: 99%

A performance score of the quality of inpatient diabetes care is a marker of clinical outcomes and suggests a cause‐effect relationship between hypoglycaemia and the risk of in‐hospital mortality

Dei

Aldigeri

Ridolfi

et al. 2020

Diabetes Metabolism Res

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Aims To build a tool to assess the management of inpatients with diabetes mellitus and to investigate its relationship, if any, with clinical outcomes. Materials and methods A total of 678 patients from different settings, Internal Medicine (IMU, n = 255), General Surgery (GSU, n = 230) and Intensive Care (ICU, n = 193) Units, were enrolled. A work‐flow of clinical care of diabetes was created according to guidelines. The workflow was divided into five different domains: (a) initial assessment; (b) glucose monitoring; (c) medical therapy; (d) consultancies; (e) discharge. Each domain was assessed by a performance score (PS), computed as the sum of the scores achieved in a set of indicators of clinical appropriateness, management and patient empowerment. Appropriate glucose goals were included as intermediate phenotypes. Clinical outcomes included: hypoglycaemia, survival rate and clinical conditions at discharge. Results The total PS and those of initial assessment and glucose monitoring were significantly lower in GSU with respect to IMU and ICU (P < .0001). The glucose monitoring PS was associated with lower risk of hypoglycaemia (OR = 0.55; P < .0001), whereas both the PSs of glucose monitoring and medical therapy resulted associated with higher in‐hospital survival only in the IMU ward (OR = 6.67 P = .001 and OR = 2.38 P = .03, respectively). Instrumental variable analysis with the aid of PS of glucose monitoring showed that hypoglycaemia may play a causal role in in‐hospital mortality (P = .04). Conclusions The quality of in‐hospital care of diabetes may affect patient outcomes, including glucose control and the risk of hypoglycaemia, and through the latter it may influence the risk of in‐hospital mortality.

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“…Diabetes and hyperglycemia are present in up to 45% of inpatients in internal medicine units. 1 – 3 In the majority of cases hyperglycemia is not the primary reason for hospitalization, but in many cases it contributes to the conditions that led to hospitalization, such as cardiovascular events, heart failure, renal failure, and infections. These diagnoses are all more prevalent in patients with diabetes, and the pathophysiology through which hyperglycemia causes or worsens these conditions has been well characterized.…”

Section: The Prevalence Of Diabetes In Internal Medicine Unitsmentioning

confidence: 99%

Managing Diabetes in Patients Hospitalized in Internal Medicine Units

Hochberg

2018

Rambam Maimonides Med J

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Diabetes and hyperglycemia are present in over one-third of inpatients in internal medicine units and are associated with worse prognosis in multiple morbidities. Treatment of inpatient hyperglycemia is usually with basal bolus insulin in a dose calculated by the patient’s weight, with lower doses recommended in patients who are at a higher risk for hypoglycemia. Other antihyperglycemic medications and insulin regimens can be used in selected patients. There are no adequately powered studies on the effect of improving glycemic control on hospitalization outcomes in non-critically ill patients in internal medicine units, and in most patients a modest glucose target of 140–180 mg/dL is recommended. A structured discharge plan should intensify antihyperglycemic treatment as needed and include an outpatient follow-up appointment shortly after discharge.

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Hyperglycemia management in patients admitted to internal medicine in Spain: A point-prevalence survey examining adequacy of glycemic control and guideline adherence

Cited by 34 publications

References 25 publications

Hyperglycemia at admission, comorbidities, and in-hospital mortality in elderly patients hospitalized in internal medicine wards: data from the RePoSI Registry

Hyperglycemia at admission, comorbidities, and in-hospital mortality in elderly patients hospitalized in internal medicine wards: data from the RePoSI Registry

A performance score of the quality of inpatient diabetes care is a marker of clinical outcomes and suggests a cause‐effect relationship between hypoglycaemia and the risk of in‐hospital mortality

Managing Diabetes in Patients Hospitalized in Internal Medicine Units

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