Aims and Rationale: People with diabetes mellitus (DM) use hospital care at higher rates and stay longer. During their stay, poor glycaemic control (hyper>hypo) is common but under-appreciated, contributing to adverse outcomes. Even when hyperglycaemia is recognised, standard care is typically sliding scale insulin. This regimen is reactive and associated with hyper- and hypo- glycaemia and does not lend itself to lasting changes to DM treatments. In contrast there is good evidence to support more complex insulin regimens traditionally used by endocrine services however local evidence is less clear.

Methods: In late 2014, the Department of Diabetes and Endocrinology of the largest tertiary referral hospital in NSW implemented a standardised basal-bolus and booster insulin protocol (3BL) for the management of all consults of inpatient hyperglycaemia in people with Type 2 Diabetes (T2D). Concurrently the records of inpatients managed with 3BL were analysed for demographic and clinical variables and to assess glycaemic measures pre and post 3BL.

Findings: We will outline the 3BL protocol, which emphasises both management and inpatient hyperglycaemia and longer term DM control. Initial analysis has been performed of 35 patients (more will be presented) managed with 3BL to show (1) their demographic and co-morbid profile and (2) a comparison of mean BGL control for standard care vs. 3BL including frequencies of hyper- and hypo- glycaemia.

Potential uses of this research: This provides an illuminating "real world" snap shot of inpatient hyperglycaemia in the largest tertiary referral hospital in NSW; should demonstrate that basal-bolus-booster insulin protocol is superior to standard care; and provides insights to how such protocols can improve both short term (inpatient) and longer term (ambulatory) glucose control.