2199-PUB: Insulin Use and Hypoglycemia Prevalence in an Australian Public Hospital Setting

Aims: Diabetes management in hospital often focuses on tight glycemic control. Insulin use is, therefore, more common in the hospital inpatient setting. We sought to determine the prevalence and patterns of insulin use and hypoglycemia among inpatients with diabetes on medical wards in a tertiary Sydney hospital.

Methods: A daily census was conducted on three medical wards (79 beds) over 44 weeks from June 2017. Inpatients with diabetes were audited using a questionnaire based on the UK National Diabetes Inpatient Audit. Those admitted for >7 days were audited for the last 7 days of admission.

Results: Among 822 patients with diabetes, 96% had T2DM, mean age (SD) was 69.1(12.3) years, 54.8% male. Overall, 29.6% were on insulin on admission but 44.7% were prescribed insulin during their hospital stay. Hypoglycemia (<4.0mmol/L) occurred in 111 patients (13.5%) with 225 episodes, and severe hypoglycemia (<3.0mmol/L) occurred in 39 patients (4.8%) with 52 episodes. Insulin was prescribed during hospital stay in 78.4% of patients who had hypoglycemia, and 92.3% who had severe hypoglycemia. There was a greater prevalence of hypoglycemia out of hours (5pm-8am) compared to 8am-5pm (167 vs. 58 episodes).

Conclusions: Hypoglycemia and severe hypoglycemia were common among hospital inpatients, and insulin use in this group was high. Insulin use was a major risk factor for hypoglycemia, particularly with new insulin initiation and after hours. These data highlight the need to weigh the risk of hypoglycemia against the benefit of tight glycemic control when considering insulin initiation in hospital. Extra vigilance is also needed after hours when there is a higher risk of hypos with fewer staff.