The Impact of Introducing Inpatient Diabetes Management Protocol on Glycemic Control in a Rural Secondary Care Hospital in the UAE

Abstract

 Background: Diabetes is one of the most common diagnoses encountered in hospitalized patients. In-hospital hyperglycemia is considered an independent marker of in-hospital poor outcome even in those without prior diagnosis of Diabetes. The purpose of this study is to evaluate the impact of introducing inpatient diabetes management protocol at Madinat Zayed hospital, a rural secondary care hospital in the Western region of Abu Dhabi, UAE. Methods: Adult, non-pregnant Patients admitted to the hospital with diabetes or a blood glucose >7.8 mmol/l (140 mg/dl) were included. The protocol guided physicians to start weight based insulin regimen for all patients with type 1diabetes, insulin dependent type 2 diabetes and all hyperglycemic patients regardless of history of diabetes. All patients who required insulin therapy were treated with basal and bolus insulin. A historical control was randomly selected for comparison. Results: 101 patients were identified in the intervention group and 69 patients in the historical control group. The mean glucose level in the treatment group was 9.2 ±3.1 mmol/l (165.6 ±55.8 mg/dl) and 12.4± 2.7 mmol/l (223±48.6 mg/dl) in the historical control group with a reduction of 26% in the mean glucose level (P<0.05). Patients with episodes of sever hyperglycemia (glucose level >16.6 mmol/l or 300 mg/dl) was significantly lower in the interventional group (23% versus 66%) with p value <0.001). There was no significant difference in the rate of hypoglycemia, length of hospital stay or healthcare associated infection between the groups. Conclusions: Inpatient diabetes management protocol can significantly decrease episodes of severe hyperglycemia and decrease mean glucose level without increasing the incidence of hypoglycemia. Our study shows that evidence-based clinical pathways can impact the quality of care in rural secondary care hospitals.