Management of the Inpatient with Diabetes Mellitus

Abstract

Abstract The previous edition of this textbook lamented on the general lack of interest in inpatient diabetes care. Since then there has been a significant change, partly brought about by increasing recognition of the significant financial burden of inpatient diabetes, increased lengths of stay, worryingly high levels of patient harms associated with poor control (both hyperglycaemia and hypoglycaemia), and poor patient experience. In England and Wales, the National Diabetes Inpatient Audit (NaDIA—vide infra), the world’s first national diabetes audit was partially instrumental in highlighting the levels of patient harms and patient dissatisfaction as well revealing the paucity of inpatient diabetes specialists. Additionally, recognizing the need to improve inpatient diabetes care the Joint British Diabetes Societies (JBDS) for inpatient care was formed to produce evidence and consensus based national guidelines to promote better care and reduce variation in practice. Similarly, in 2013, diabetes specialists in the United States formed a consortium for Planning Research in Inpatient Diabetes (PRIDE) to improve inpatient diabetes care. Thus, driven by evidence of suboptimal management and the associated high costs, inpatient diabetes care has now become a major focus for funders, hospital management, clinicians, and patients. The goal should be to ensure that the outcomes for people with diabetes admitted to hospital are no different from those without diabetes by prevention of inpatient hyperglycaemia, hypoglycaemia, and hospital acquired foot lesions and ensuring early and safe discharge.