Routine admission screening of patients is desirable, but financial and personnel support for diabetes services is essential
Hyperglycaemia is common among hospitalised patients and is associated with increased complication rates, longer admissions, more frequent re‐admissions, and higher mortality.1,2,3,4 Its detection can also be an opportunity for identifying undiagnosed diabetes. Trials have confirmed that improving inpatient glycaemic control reduces complication rates,2 and guidelines recommend that the blood glucose levels of all patients be checked on admission; if hyperglycaemia is detected, glycated haemoglobin (HbA1c) should also be measured.2,5 HbA1c assessment can help differentiate stress‐induced hyperglycaemia from undiagnosed diabetes, and also aids evaluation of treatment adequacy in people with known diabetes. Nevertheless, the identification of undiagnosed diabetes in hospitalised patients is sub‐optimal.
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- 1. Bach LA, Ekinci EI, Engler D, et al. The high burden of inpatient diabetes mellitus: the Melbourne Public Hospitals Diabetes Inpatient Audit. Med J Aust 2014; 201: 334–338. https://www.mja.com.au/journal/2014/201/6/high-burden-inpatient-diabetes-mellitus-melbourne-public-hospitals-diabetes.
- 2. Umpierrez GE, Hellman R, Korytkowski MT, et al. Management of hyperglycemia in hospitalized patients in non‐critical care setting: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97: 16–38.
- 3. Baker ST, Chiang CY, Zajac JD, et al. Outcomes for general medical inpatients with diabetes mellitus and new hyperglycaemia. Med J Aust 2008; 188: 340–343. https://www.mja.com.au/journal/2008/188/6/outcomes-general-medical-inpatients-diabetes-mellitus-and-new-hyperglycaemia.
- 4. Mahendran DC, Hamilton G, Weiss J, et al. Prevalence of pre‐existing dysglycaemia among inpatients with acute coronary syndrome and associations with outcomes. Diabetes Res Clin Pract 2019; 154: 130–137.
- 5. American Diabetes Association. Diabetes care in the hospital: Standards of Medical Care in Diabetes: 2019. Diabetes Care 2019; 42: S173–S181.
- 6. Cheung NW, Campbell LV, Fulcher GR, et al. Routine glucose assessment in the emergency department for detecting unrecognised diabetes: a cluster randomised trial. Med J Aust 2019; 211: 454–459.
- 7. Tong EY, Roman CP, Mitra B, et al. Reducing medication errors in hospital discharge summaries: a randomised controlled trial. Med J Aust 2017; 206: 36–39. https://www.mja.com.au/journal/2017/206/1/reducing-medication-errors-hospital-discharge-summaries-randomised-controlled.
- 8. Kyi M, Colman PG, Wraight PR, et al. Early intervention for diabetes in medical and surgical inpatients decreases hyperglycemia and hospital‐acquired infections: a cluster randomized trial. Diabetes Care 2019; 42: 832–840.
Jonathan Shaw is supported by a National Health and Medical Research Council (NHMRC) Senior Research Fellowship. This work was partly supported by the Victorian Operational Infrastructure Support Program. Matthew Hare is supported by an NHMRC Postgraduate Scholarship, the Australian Academy of Science Douglas and Lola Douglas Scholarship, and the NHMRC/Diabetes Australia Postgraduate Award.
Jonathan Shaw has received honoraria for lectures and consultancies from Astra Zeneca, Eli Lilly, Mylan, Novo Nordisk, Sanofi, Merck Sharp and Dohme, Abbott, and Boehringer Ingelheim.