LBODP059 In-patient Hyperglycemia Among Non-critically Ill Patients Admitted At The University Of Santo Tomas Hospital, A Tertiary Teaching Hospital: A Prospective Study

Abstract

Abstract Several societies provide in-hospital diabetes care guidelines on admission HbA1c, insulin initiation, sliding scale avoidance, and adoption of hypoglycemia protocol. This study aimed to determine the contemporary state of diabetes management and compliance to guidelines in the University of Santo Tomas Hospital, a tertiary teaching hospital, among non-critically ill patients from September-December 2021. A descriptive prospective study of in-patients with hyperglycemia was done. Exclusion criteria included hyperglycemic crisis, intensive care admission and gestational diabetes. Primary outcome was median capillary blood glucose (CBG) on admission compared to discharge and upon treatment modification stratified according to regimen and diagnoses (infection, surgery, diagnostic procedures and non-infectious medical). A total of 127 eligible patients were included with a mean age of 64 years with male predominance. Baseline median HbA1c was 7% [6.2-8.2]. The incidence of in-patient hyperglycemia (i. e., individual CBG reading >180 mg/dL) was 36% with highest proportion in the infection group. Fifty seven percent had at least one reading of hyperglycemia during hospital stay. The most common admission transition practice was resumption of home diabetes regimen with modified dose. The most common in-patient regimen was insulin therapy (largely, correctional scale alone, 47%) followed by oral hypoglycemic agents (OHA), mostly dipeptidyl peptidase inhibitors. Change in CBG among the basal-bolus group was significantly higher compared to OHA (p 0. 0002), insulin+OHA (p 0. 0183), basal (p 0. 0187), and correctional (p<0. 00001). Patients on insulin+OHA showed a significant change in percentage hyperglycemia across CBG readings (p 0. 0006). In the infection group, greatest median change in CBG was in basal-bolus (77mg/dL) followed by insulin+OHA (46mg/dL). Median change did not significantly differ by type of regimen with other diagnoses. Correctional scale was ordered in 95% of patients and was not associated with hypoglycemia (p 1. 000). There was no difference in the development of hypoglycemia by any type of regimen as well (p 0.134). Only elevated admission HbA1c was associated with persistent hyperglycemia (p 0. 050). Response to hyperglycemia differed (p<0. 0001) between endocrinologists (dose up-titration and shift to basal+bolus+OHA) and other services (dose maintenance). Percentage CBG on target did not differ between the two but compliance to discharge guidelines (provision of discharge, follow-up and dietary instructions) were lower among patients not referred to endocrinology (p <0. 0001). Basal-bolus still provide the most effective coverage followed by insulin+OHA even on infection group. For a more wholistic in-patient care, review of guidelines for non-endocrinology services is recommended to improve discharge transition practices. Presentation: No date and time listed