Glycemic control and diabetes management in hospitalized patients in Brazil

Diabetology & Metabolic Syndrome

Maria da Conceição C Almeida²  Zaira Onofre Nunes²  Clodoaldo Souza Jr¹  Raimundo Celestino Silva Neves²  Patricia Carvalho Balthazar Silveira¹  Edson Duarte Moreira Jr² 

[1] Clinical Research Center, Charitable Works Foundation of Sister Dulce, Av. Bonfim 161, Salvador, Bahia, Brasil 40.415-000;Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcão 121, Salvador, Bahia, Brasil 40.296-710

关键词: Brazil;    Epidemiology;    Diabetes mellitus;    Hospitals;    Inpatients;    Glycemic control;   

Others  :  812641
DOI  :  10.1186/1758-5996-5-62

 received in 2013-07-12, accepted in 2013-10-07,  发布年份 2013

【 摘 要 】

Background

The importance of tight blood glucose control among outpatients with diabetes mellitus is well established, however, the management of diabetes in the hospital setting is generally considered secondary in importance. This study sought to assess glycemic control and diabetes management in adult patients admitted to hospitals in Brazil.

Methods

A cross-sectional and nationwide survey was conducted from July 2010 to January 2012. Eligible cases were 18 years of age or older, had a diagnosis of diabetes and a hospitalization length of stay ≥72 hours. Socio-demographic information, hospitalization details, and data on diabetes diagnosis, management and treatment were collected for all patients by chart review. Information on all blood glucose (BG) readings for a maximum of 20 consecutive days of hospitalization was recorded for each patient.

Results

Overall, 2,399 patients were surveyed in 24 hospitals located in 13 cities from all five Brazilian regions. The prevalence of patients presenting hyperglycemic (BG >180 mg/dL) or hypoglycemic (BG <70 mg/dL) events was 89.4% and 30.9% in patients in general wards, and 88.2% and 27.7% in those in Intensive Care Units (ICUs), respectively. In addition, a BG measure >180 mg/dL was recorded in two-thirds of the patient-days. A high proportion of patients were treated with sliding-scale insulin regimen alone in the general wards (52.0%) and in the ICUs (69.2%), and only 35.7% and 3.9% received appropriate insulin therapy in general wards (basal + bolus insulin) and in ICUs (continuous IV insulin), respectively.

Conclusions

Inpatient glycemic control and diabetes management needs improvement. Opportunities to improve care in Brazilian hospitals include expanded use of intravenous insulin and subcutaneous basal-bolus insulin protocols, avoiding use of sliding-scale insulin alone, increased frequency of blood glucose monitoring, and institution wide quality improvement efforts targeting both physician and nursing behavior.

【 授权许可】

   
2013 Moreira et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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