Is all hypoglycaemia treated as equal? An observational study of how the type of diabetes and treatment prescribed prior to admission influences quality of treatment of inpatient hypoglycaemia

Abstract

AimsInpatient hypoglycaemia is common and associated with adverse outcomes. There is often increased vigilance of hypoglycaemia in inpatients with type 1 diabetes (T1DM) compared to type 2 diabetes (T2DM). We aimed to investigate this apparent discrepancy, utilising the time to repeat (TTR) capillary blood glucose (CBG) measurement as a surrogate for engagement with guidelines stating that CBG should be rechecked following intervention within 15 min of an initial CBG of <4 mmol/L.MethodsThis is an observational study of inpatient CBG data from 8 hospitals over a 7-year period. A national diabetes registry allowed identification of individual’s diagnosis and diabetes therapy. For each initial (index) CBG, the TTR for individuals with T2DM—on insulin or sulphonylurea—was compared with the TTR for individuals with T1DM, using a t test for significance performed on log(TTR). The median TTR was plotted for each group per index CBG.ResultsIn total, 1480,335 CBG measurements were obtained. A total of 26,664 were <4 mmol/L. The TTR in T2DM individuals on sulphonylurea was significantly greater than in T1DM individuals where index CBG was ≥2.3 mmol/L (except index CBG 2.6 mmol/L). For T2DM patients receiving insulin significance exists for index CBGs of ≥3.2 mmol/L.ConclusionsThis analysis suggests that quality of care of hypoglycaemia varies according to diagnosis and medication. The group with the highest TTR (T2DM sulphonylurea treated) are possibly the clinical group in whom hypoglycaemia is most concerning. These data therefore suggest a need for education and raising awareness within the inpatient nursing staff.

Predictors of Time-to-Repeat Point-of-Care Glucose Following Hypoglycemic Events in Hospitalized Patients

“…In this regard, our findings align with the previous studies showing very low rates of adherence to this component of the hypoglycemia treatment protocol for hospitalized patients. 13-18 A study from the United Kingdom conducted from 2008 to 2013 found 8.9% had a repeat POCG within 15 minutes and a median (IQR) TTR of 80 (36-249) minutes, 13 indicating even lower rates of adherence compared to our US based study. Another study found that only 9% of patients had a TTR within 10 to 20 minutes of a hypoglycemic episode.…”

“…Previous studies have demonstrated a strong association between the severity of hypoglycemia and TTR. 13,17,20 We evaluated the index POCG as a continuous measure and as a categorical variable according to the International Hypoglycemia Study Group consensus statement as follows: 54 to 70 mg/dL (mild/moderate) and 40 to 53 mg/dL (clinically significant). 27 Consistent with other studies, we considered <40 mg/dL to be severe hypoglycemia.…”

“…9,11,12 Several studies have shown that adherence to the recommendation to repeat a POCG within 15 minutes following hypoglycemia treatment is low. [13][14][15][16][17][18][19][20] Studies have shown a direct association between the hypoglycemic POCG value and the time-to-repeat (TTR) POCG, 13,14,20 indicating that primary healthcare responders (typically nurses) take into account the severity of hypoglycemia in determining the acuity of their response; however, whether patient or hospital factors besides the hypoglycemic POCG value itself are associated with TTR has not been well studied. One study found that median TTR differed by diabetes type and insulin use, but a formal statistical analysis was not provided.…”

“…One study found that median TTR differed by diabetes type and insulin use, but a formal statistical analysis was not provided. 17 We suspect that other patient and systems' factors beyond the hypoglycemic value influence the healthcare team's responsiveness to a hypoglycemic episode.…”

Cuidados de enfermería para la persona adulta, diabética con hipoglucemia: revisión integrativa

“…[27][28][29] En la categoría atención brindada al paciente la evidencia muestra que las personas diabéticas requieren un equipo de salud capacitado, que los ayude a generar control general de la enfermedad para evitar complicaciones como la hipoglucemia, mediante una atención personalizada, se recomienda atención por la especialidad de endocrinología, que permita el análisis efectivo de la situación clínica actual para establecer las metas terapéuticas deseadas con un régimen de medicamento adecuado. [30][31][32][33][34] En la categoría disminución de la hipoglucemia se evidencia en los estudios la implementación de intervenciones y planes de acción encaminados a la atención y educación del paciente con el objetivo de reducir la hipoglucemia en el paciente adulto con DM. [35][36][37][38][39][40] La categoría impacto de la hipoglucemia muestra que gran proporción de los pacientes presentan hipoglucemias severas, requiriendo así la asistencia de una ambulancia médica; frente a la hipoglucemia nocturna se evidenció que afecta potencialmente la capacidad del paciente para despertarse y responder con una ingesta adecuada de carbohidratos, entre otros síntomas.…”