The high burden of inpatient diabetes mellitus: the Melbourne Public Hospitals Diabetes Inpatient Audit

Abstract

Objective: To determine the prevalence of diabetes in inpatients in Melbourne hospitals. Design: Point prevalence survey of all inpatients in each hospital on a single day between 30 November 2010 and 22 November 2012. Setting: 11 hospitals in metropolitan Melbourne including community, secondary and tertiary hospitals and one aged care and rehabilitation centre. Participants: 2308 adult inpatients in all wards apart from intensive care, emergency, obstetrics and psychiatry. Main outcome measures: Point prevalence of self-reported diabetes, details of current medication, self-reported frequency of complications. Results: Diabetes status was obtained in 2273 of 2308 inpatients (98.5%). Of these, 562 (24.7%) had diabetes (95% CI, 22.9%-26.5%). Diabetes prevalence ranged from 15.7% to 35.1% in diff erent hospitals (P < 0.001). Patients with diabetes were older, heavier and more likely to be taking lipidlowering, antihypertensive and blood-thinning medications. Of 388 patients with complete medication information, 270 (69.6%) were taking oral hypoglycaemic agents alone or in combination with insulin, 158 (40.7%) were treated with insulin (67 [17.3%] with insulin alone) and 51 (13.1%) were not taking medication for diabetes. The frequency of diabetes complications was very high: 207/290 (71.4%) for any microvascular complication, 275/527 (52.2%) for any macrovascular complication and 227/276 (82.2%) for any complication. Conclusion: The high burden of diabetes in Melbourne hospital inpatients has major implications for patient health and health care expenditure. Optimising care of these high-risk patients has the potential to decrease inpatient morbidity and length of stay as well as preventing or delaying future complications. A formal Australian national audit of inpatient diabetes would determine its true prevalence and consequences, allowing rational planning to deal with shortcomings in its management.

Quantifying the hidden healthcare cost of diabetes mellitus in Australian hospital patients

“…Our study highlights the high indirect attributable burden of DM on hospitalisation costs. Although limited to a subgroup of non‐surgical, non‐obstetric hospitalised adults, the 33% DM prevalence in GIM patients accorded well with previously documented DM prevalence throughout our entire Health Service . We found that, following adjustment for confounders, patients with comorbid DM had a 1.22‐fold higher ICC and 1.19‐fold increased odds of staying longer in hospital.…”

“…Indeed recent studies in our setting have shown that this approach may underestimate the real prevalence of diabetic complications (that approaches 80% when determined by a carefully structured interview). Therefore, our comparisons between these two groups should be interpreted cautiously …”

“…However, existing estimates of DM‐related hospital costs have been derived from hospital data from patients admitted with DM as a primary diagnosis, and do not account for more indirect effects on health costs that might result from DM being present as a comorbidity. A recent study demonstrated that in Melbourne, overall DM prevalence in hospital inpatients was as high as 35% . However, in only a relatively small proportion of these was the admission primarily attributed to DM.…”

Using Routine Hemoglobin A1c Testing to Determine the Glycemic Status in Psychiatric Inpatients

“…We recently showed that approximately one-third of general inpatients aged >54 years admitted to our hospital had type 2 diabetes (4). A recent Melbourne Public Hospitals Diabetes Inpatient Audit revealed the prevalence of diabetes ranged from 16 to 35% in different hospitals across the greater metropolitan region (5). …”

The independent associations of HbA1c, C-reactive protein and birth weight with cardiovascular disease, diabetes mellitus and chronic kidney disease in a remote Indigenous Australian community: a prospective cohort study

“…A recent study in Melbourne hospitals found that the prevalence of diabetes in hospitalised patients ranged from 15.7 % to 35.1 %, and over 82 % of diabetes patients suffered from microvascular or macrovascular complications [67].…”