People with diabetes account for 15% of inpatients in England, according to an audit published by NHS Diabetes. Analysing clinical data of over 12,000 inpatients with diabetes from 206 hospitals as well as nearly 5,000 patient questionnaires, the ‘National Diabetes Inpatient Audit (NaDIA) 2010 (England)’ also found that at the time of the audit people with diabetes had been in hospital for an average of eight days, approximately three days longer than all inpatients. Nearly all (86.7%) were admitted as an emergency.
The audit also discovered that over one third (37.1%) of inpatients with diabetes experienced at least one medication error, a quarter (26.0%) of their charts had prescription errors and a fifth (20.0%) had one or more medication management errors. Insulin overdoses can result in potentially fatal hypoglycaemic episodes (‘hypos’) and insufficient insulin can lead to diabetic ketoacidosis (DKA) which, if left untreated, can also prove fatal.
The audit found that patients with medication errors had twice the rate of severe hypoglycaemia (18.1 vs 7.9%). Of further concern, whilst in hospital 44 people (0.4%) developed DKA and 266 (2.4%) had hypoglycaemia severe enough to require injectable treatment.
Other findings from the results, which were analysed by data experts at Diabetes Health Intelligence, a strategic programme of Yorkshire and Humber Public Health Observatory, found:
- 31% of sites had no inpatient diabetes specialist nurses
- 69.4% of inpatients with diabetes had not been seen by a member of the diabetes team
- 27.2% reported that choice, and 22.7% timing, of meals was only sometimes or rarely suitable for managing their diabetes effectively. People who reported poor choice and timing of food were more likely to have a severe hypoglycaemic episode whilst in hospital.