PREVALENCE OF INPATIENT HYPERGLYCEMIA AND GLYCEMIC CONTROL IN GENERAL MEDICAL WARDS PUTRAJAYA HOSPITAL

Introduction: Inpatient hyperglycemia is to describe inpatients with diabetes and stress hyperglycemia (SH). Prevalence of inpatient hyperglycemia is ranging from 38% to 45%, with 12% had SH. Inpatient hyperglycemia is common and associated with adverse outcomes such as longer hospital stays and higher mortality. Objectives: To determine the prevalence of inpatient hyperglycemia in general medical ward, Putrajaya Hospital. To determine glycemic control among patients with inpatient hyperglycemia. To compare (1) length of stay (LOS); (2) 30-days readmission rate; and (3) death during admission between controlled and uncontrolled glycemic groups. Methods: Patients admitted to general medical wards with blood glucose value >7.8 mmol/L with ≥24 hours of stays from July 1st to December 31st, 2019 were identified. ❑ Demographic data, diabetes history, blood glucose profiles and admission notes were retrieved. ❑ Controlled glycemic status was defined when the blood glucose readings between 4.0 to 10 mmol/l were ≥80%. ❑ Exclusion criteria: (1) ICU admission, (2) diabetic emergency, (3) Type 1 DM, (4) pregnancy, (5) steroid usage, (6) advanced chronic kidney disease (CKD) and (7) palliative care. Results: Out of 2631 admissions, 1453 had hyperglycemia. Therefore, prevalence of inpatient hyperglycemia was 55.2% (38.9% had diabetes and 16.3% had SH). Total of 612 (42.1%) patients were excluded. Thus, 841 patients were further analyzed and we found out 452 (53.7%) patients had uncontrolled blood glucose. Discussions: The prevalence of hyperglycemia in our study was higher than in China (55.2% vs 45.7%) as majority of our patients were Malays, albeit both wereAsian countries and capturing medical patients. More than half of our patients had uncontrolled blood glucose. They were younger, had higher HbA1c level and admitted with more kidney complications compared to the controlled group. With the mean age of 64 in both glycemic groups, ZA Adrienne et. al found out 47.7% of their patients had uncontrolled blood glucose. Their study involved admission to medical and non medical wards and counted blood glucose starting at 48 hours after admission which could explained better glycemic control achieved when most of acute phase of illness has resolved. We did not find any difference in LOS between two glycemic groups as in our practice, patients with uncontrolled blood glucose were seen by diabetes educators in the wards and were reviewed early in endocrine clinic after discharged. Average LOS in our study was shorter than few studies which was around six days because those studies included patients in ICU where longer LOS is expected. Uncontrolled group had higher percentage of 30-days readmission rate. Although it was statistically not significant as found in ZA Adrienne et. al, their patients were readmitted for exacerbations of the most frequent diagnoses which were chronic obstructive pulmonary disease and heart failure. Overall percentage of death in our study was considerably low. Our study only involved patients in general medical wards, which differs from studies with higher mortality rate whereby ICU patients were included. Conclusions: The prevalence of inpatient hyperglycemia was high. More than half of them had uncontrolled blood glucose. Both groups had similar average LOS. Thirty-days readmission rate and death were higher in uncontrolled group although statistically not significant.