Glycemic Control in hospitalized patients in a Tertiary Care Hospital.

Ms Vaishnavi Reddy M; Dr Srinivas Jakkinaboina; Dr Bhasker Tammali; Dr Geetadevi Yammala

Volume : VI, Issue : XI, November - 2017

Glycemic Control in hospitalized patients in a Tertiary Care Hospital.

Ms Vaishnavi Reddy M, Dr Srinivas Jakkinaboina, Dr Bhasker Tammali, Dr Geetadevi Yammala

Abstract :

Introduction -The purpose of this study was to understand the practices of glycemic control, management and outcomes in hospitalized patients at Citizens Specialty Hospitals for a period of 10days.

Methods - The cross-sectional survey was conducted to know the glycemic control and management of all adult patients admitted to Citizens specialty hospital for a period of 10days.

Study population - All the patients admitted to Citizens Specialty Hospital were enrolled. The exclusion criteria were a) Age <18 years b) post transplantation c) Palliative care during hospitalization d) malignancy. The study protocol was approved by hospital Ethical Review Board.

Data collection - The following are the parameters collected from the patients. Age, sex, diagnosis, Hospital ID Number, number of Days in the hospital, diabetic, ventilator support, ICU or non ICU admission, comorbidities, organ failure, serum creatinine, steroids, mean glucose levels, use of oral hypoglycemic agents / insulins, frequency of monitoring of blood sugars and outcomes. Depending on the glucose levels divided into 5 groups a) blood sugar < 40mg/dl b) blood sugar 40- 70mg/dl c) blood sugar 80- 110 mg/dl d) blood sugar 110 – 180 mg/dl e) blood sugar > 180 mg/dl. All the wards and the (ICU) Intensive care units (surgical ICU, Medical ICU, cardiac ICU) are included in this study.

Statistical analysis- Each patient�s mean BG level for the entire hospitalization as a single data point. Statistical analyses were performed with Stata version 12.

Results- The total number of patients enrolled were 246 in 10 days duration. All the enrolled patients were followed till In-hospital discharge or death of the patients. Of 246 total patients 66.7% patients were male and 33.3% were female. Significant number of patients 86 (35%) were admitted to ICU. The mean age was 47.78 years. The mean blood glucose was 140mg/dl. The hospital ALOS was 4.9 days. Every patient admitted to the hospital were monitored blood sugar. 58.5% of admitted patients blood sugars were monitored only at admission.

The glycemic control is within acceptable range (blood sugar 80 mg/dl – 180 mg/dl) were 57.8%. The blood sugars above 180mg/dl were 38.21%. 10 (4%) patients had blood glucose between 40- 70mg/dl and None of the patients had blood sugar <40 mg/dl. The most common co-morbidities of the patient were Diabetics 33.3%. Hypertension, coronary artery disease, chronic kidney disease and cereovascular disease were 13.8%, 4%, 1.6%, 1.6% respectively. 49.6% of the patients had no comorbidities.

The most common organ failure were cardiac failure 20.3% followed by respiratory failure 13%. The most common causes for the hospital admission were cardiac failure and sepsis with 22.8% and 22.3% respectively. The overall In-hospital mortality were ( 4%) 10 patients.

The Non ICU and ICU In-hospital mortality were 4 and 6 patients with 2.5% and 7% respectively. The mortality in the ICU patients were high due to higher organ failure.

Conclusion- Overall glycemic control in the hospital is acceptable. ICU patients had better control of blood sugars than Non ICU patients. Diabetics had increased hospital LOS. Non diabetics also need to have better control of blood sugars. Frequent monitoring, training and protocols implementation can improve the blood sugar control in the hospital.