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One in four hospitalized patients may have diabetes
Nearly one in four adults hospitalized in Germany have diabetes and are at greater risk for complications and longer hospital stays compared with adults without diabetes, study data show.
Andreas Fritsche, MD, of the department of internal medicine IV, University Hospital Tübingen in Germany, and colleagues evaluated data on 3,733 adult patients (mean age, 59.13 years; 50.07% women) from Tübingen University Hospital screened for diabetes and prediabetes over a 4-week period to determine diabetes prevalence, proportion of undiagnosed cases, effectiveness of diabetes screening in a university hospital, consequences for hospital stay and acquired complications.
Mean length of hospital stay was 8.33 days, and 17.25% of participants developed at least one complication during hospitalization.
Overall, 54.17% of participants had no diabetes, 23.68% had prediabetes, and 22.15% had diabetes. Prevalence of diabetes was highest in the ICU (> 40%). Prevalence of unknown or undiagnosed diabetes was 3.67%. Based on an HbA1c measurement of 6.5% or more, 14.6% of participants had diabetes.
The difference between the mean length of hospital stay and actual duration of stay was significantly higher among participants with diabetes (22.53 days) compared with participants without diabetes (16.79 days; P = .0232). Participants with diabetes or prediabetes were more likely to have complications compared with participants without diabetes (P < .0001).
“Diabetes is a diagnosis frequently present in hospitalized patients,” Fritsche told Endocrine Today. “Diabetes screening with HbA1c measurements is worthwhile in patients older than 50 years. A diabetology department should be available in every larger hospital which organized the care and therapy of inpatients with diabetes.” – by Amber Cox
For more information:
Andreas Fritsche, MD, can be reached at andreas.fritsche@med.uni-tuebingen.de.
Disclosures: Fritsche reports no relevant financial disclosures. Please see the study for a list of all other authors’ relevant financial disclosures.
Perspective
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The work by the experienced group of Kufeldt colleagues touches on several important aspects of inpatient diabetes care that, for the most part, remain poorly addressed in the United States. First, clinicians must be more aware that diabetes is a major problem in the hospital setting affecting almost one in four patients. It is well-known that diabetes is associated with an extended length of hospital stay and more complications. In this study, diabetic complications extended the length of stay by 5 days. The added expense is obviously considerable. Second, that only 34% of patients with diabetes had HbA1c recordered gives a sense that diabetes status is not taken as a high priority in the inpatient setting (HbA1c screening is probably even less in the U.S.). This continues even as the American Diabetes Association and most other national guidelines have recommended for a long time ordering HbA1c measurement upon admission in all patients with hyperglycemia (any plasma glucose >140 mg/dL). The rationale is to separate patients with prediabetes developing hyperglycemia from acute illness from those with diabetes. Measuring HbA1c is a golden opportunity to assess outpatient control, establish a new diagnosis of diabetes and initiate diabetes education as well as to develop a proper discharge plan. In this study it was also a cost-effective approach at less than $100 per new diagnosis of diabetes (slightly higher in the U.S.). Finally, all patients with diabetes in this German tertiary care hospital received a consultation by the diabetes care team, a standard not always followed in the U.S. This likely helped keep the mean adjusted length of stay attributable to diabetes to only 1 extra day. Leadership across hospitals in the U.S. should prioritize such teams to optimal care.