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

Leon A Bach, Elif I Ekinci, Dennis Engler, Chris Gilfillan, P Shane Hamblin, Richard J MacIsaac, Georgia Soldatos, Cheryl Steele, Glenn M Ward and Sue Wyatt
Med J Aust 2014; 201 (6): 334-338. || doi: 10.5694/mja13.00104

Summary

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 different hospitals (P < 0.001). Patients with diabetes were older, heavier and more likely to be taking lipid-lowering, 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.

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  • Leon A Bach1,2
  • Elif I Ekinci3,4
  • Dennis Engler5,2
  • Chris Gilfillan6,2
  • P Shane Hamblin7,1,4
  • Richard J MacIsaac8,4
  • Georgia Soldatos5,2
  • Cheryl Steele7
  • Glenn M Ward8,4
  • Sue Wyatt1

  • 1 Alfred Health, Melbourne, VIC.
  • 2 Monash University, Melbourne, VIC.
  • 3 Austin Health, Melbourne, VIC.
  • 4 University of Melbourne, Melbourne, VIC.
  • 5 Monash Health, Melbourne, VIC.
  • 6 Eastern Health, Melbourne, VIC.
  • 7 Western Health, Melbourne, VIC.
  • 8 St Vincent's Hospital, Melbourne, VIC.

Correspondence: leon.bach@monash.edu

Acknowledgements: 

The authors would like to thank Ghazaleh Ahmadi (Eastern Health) and Alan McCubbin (Austin Health) for assistance with collating data. We would also like to thank the numerous dietitians, diabetes nurse educators, hospital medical officers, registrars, endocrinologists and medical students who assisted in data collection.

Competing interests:

No relevant disclosures.

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