Control hospitalario de la diabetes y de la hiperglucemia: una auditoría en hospitales españoles

Abstract

ObjectivesEvaluation of the quality of care for patients with diabetes mellitus admitted to hospitals in Spain. MethodsCross-sectional study in one day that included 1193 (26.7%) patients with type 2 diabetes or hyperglycemia out of 4468 patients admitted to the internal medicine departments of 53 hospitals in Spain. We collected demographic data, adequacy of capillary glycemic monitoring, treatment administered during admission, and recommended therapy at discharge. ResultsThe median age of the patients was 80 years (74-87), of which 561 (47%) were women, with a Charlson index of 4 points (2-6), and 742 (65%) were fragile. Median blood glucose on admission was 155mg/dL (119-213). On the third day, the number of capillary blood glucose levels in target (80-180mg/dL) was pre-breakfast 792/1126 (70.3%), pre-lunch 601/1083 (55.4%), pre-dinner 591/1073 (55.0%) and night 317/529 (59.9%). A total of 35 patients (0.9%) were suffering from hypoglycemia. Treatment during hospitalization was performed with sliding scale insulin in 352 (40.5%) patients, with basal insulin and rapid insulin analogs in 434 (50%), or with diet exclusively in 101 (9.1%). A total of 735 (61.6%) patients had a recent HbA1c value. At the time of discharge, the use of iSGLT2 increased significantly (30.1% vs. 21.6%; p<0.001), as well as the use of basal insulin (25.3% vs. 10.1%; p<0.001). ConclusionsThere is an excessive use of insulin on a sliding scale as well as deficient information on HbA1c values and an even deficient prescription at the discharge of treatments with cardiovascular benefit.