EVALUATION OF IN-PATIENT HYPERGLYCEMIA MANAGEMENT AMONG NON-CRITICALLY ILL PATIENTS AT THE UNIVERSITY OF SANTO TOMAS HOSPITAL (USTH):

A PROSPECTIVE STUDY

Abstract

OBJECTIVES
Approximately 64% of in-patients with hyperglycemia had pre-existing diabetes. This study aimed to assess adherence to in-patient hyperglycemia management guidelines and outcomes in non-critically ill patients at the University of Santo Tomas Hospital

METHODOLOGY
A prospective analytical study of in-patients with hyperglycemia or diabetes mellitus type 2 from September- December 2021 was done. A checklist based on recent in-patient hyperglycemia recommendations was used to assess management and conformity to guidelines.

RESULTS
A total of 127 patients were included. HbA1c was measured in 57% of these patients. The incidence of in- patient hyperglycemia was 36% with highest proportion among admissions for infection. The most common (28%) regimen on admission was resumption of home medications with modified dose. Standard hospital glucose monitoring [USTH Point-of-Care (POC) testing] was applied, however, occasional delays in testing caused lack of coordination between insulin injections and meals. Eighty-eight percent of elective surgery patients received pre-admission treatment for hyperglycemia. Referral to endocrinologists was done in 76 patients. A shift to insulin therapy for persistent hyperglycemia (>180 mg/dL) was done in 15% of patients who were insulin naive. Overall, target capillary blood glucose (CBG) range of 140 to 180 mg/dL was achieved in 97% of patients. The median CBG of 145 mg/dl on admission was lowered to 132 mg/dL on discharge (p<0.00001). Compliance to discharge and follow- up instructions were poorer among non-endocrinologists (p<0.0001).

CONCLUSION
This study demonstrated prompt management upon admission according to guidelines but also showed delays in insulin initiation and endocrine referrals in response to persistent hyperglycemia, inconsistent timing of monitoring in relation to meals, and poor discharge practices among non-endocrinologists—areas which need improvement.