The Increasing Burden of In-Hospital Diabetes; the Hobart Experience — ASN Events
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The Increasing Burden of In-Hospital Diabetes; the Hobart Experience (#349)

Anna Galligan 1 , John R Burgess 1 2 , Anne Duffield 1 2 , Tim M Greenaway 1 2 , Roland W McCallum 1 2
  1. Department of Endocrinology, The Royal Hobart Hospital, Hobart, TAS, Australia
  2. The School of Medicine, University of Tasmania, Hobart, TAS, Australia

We aimed to compare the prevalence and management of patients with diabetes mellitus on a single day in a Tasmanian teaching hospital in 1998, 2008 and 2011.


Data was collected as a prospective audit from each inpatient on a single day admitted to a tertiary referral teaching hospital during July in 1998, 2008 and 2011. Prevalence of diabetes mellitus, length of stay, medications, new incident hyperglycaemia, deaths, discharge documentation and methods of treating glycaemia, blood pressure and lipids were recorded.


The prevalence of in-hospital diabetes in 1998, 2008 and 2011 was 8%, 14% and 20% respectively. Among these patients, there was a reduction in the percentage of type one diabetes in each subsequent year (20% in 1998, 14% in 2008, 4% in 2011.) 5.5% of inpatients in 2011 had a random glucose ≥11.1 mmol/L during their admission without a previous diagnosis of diabetes. None of these patients had the elevated glucose mentioned on their discharge letter. In 2011 there was an increased frequency in monitoring and less inappropriate use of metformin, but this was not associated with an improvement in the number of patients who experienced hyperglycaemia. Fewer patients had hypoglycaemic episodes, however these patients were more likely to receive inappropriate treatment for their hypoglycaemia in 2011. The proportion of patients who had achieved an HbA1C < 7% in the preceding 6 months was comparable in all three years, as were mean blood pressure readings. Lipid profiles were managed more effectively in 2011 and 2008 compared with 1998.


There has been an ever-increasing burden of patients with diabetes in the hospital population over the last 13 years. This audit showed an expected predominance of type two diabetes. Despite advances in monitoring, education and pharmacological options, there has been no discernible improvement in the incidence of hyperglycaemia on the ward or number of patients achieving an HbA1c below 7%. Ongoing efforts including in-hospital diabetes management teams and programs to increase the awareness of the importance of hospital glycaemic control may contribute to improved outcomes in subsequent years.