| Objectives:This study was to investigate the prevalence of diabetes among the inpatients of 3-A Hospitals, and the status of blood glucose management the diabetes patients. We aimed to increase the awareness of significance of blood glucose management in hospitals, and discover the problems, so as to have a better blood glucose control among the inpatients after setting up corresponding solutions.Methods:We chosed three 3-A hospitals in Nanjing by convenience sampling, which have to have more than seven hundred beds.3 hospital picked one day in three different months(November 2014, December 2014, January 2015, respectively) to do the survey. Inpatients who stayed in the hospital from 8:00 to 20:00 were chosen to the subjects. Patients who had diabetes and nondiabetes whose fasting blood glucose(FBG) was more than 6.1mmol/L were included. A self-designed case report form was used in this study.Results:1. The total prevalence of diabetes was 17.8%. Of the 5398 inpatients,16.9% were diagnosed with diabetes before,0.9% was newly diagnosed. Only 18 (3.1%) patients with impaired glucose regulation underwent oral glucose tolerance test (OGTT) and 210 (36.6%) diabetes patients had their HbAlc checked, and the percentage was 3.1% and 36.3%, respectively.2. Among the hospitalized diabetic patients, only one sixth were in the department of endocrinology. Departments other than endocrinology also had patients with diabetes accounting for more than 20% of all the patients were geriatrics(36.2%), nephrology(33.3%), cardiology(32.1%), neurology (27%), vascular surgery(23.9%), emergency internal medicine(23.2%), department of Chinese medicine(23%).3. There were 786 nonsurgical patients among all the hospitalized diabetes patients, of which 547 (69.6%) having HbAlc tested,38% of the nonsurgical patients reaching the goal of HbAlc<7%. Of 176 surgical patients,77 (43.8%) had HbAlc tested, of which 18.2% reaching the goal of HbAlc<7%.4. When patients was discharged from hospitals, the percentage of lifestyle and oral treatment decreased to 8.7% and 35.9%, from 14.7% and 45.9%. However, the percentage of insulin and oral plus insulin treatment increased to 30.3% and 25.2%, from 24.2% and 15.1%. Also, insulin use had increased 16.2%.5. Of 338 nonsurgical patients with poor glycemic control,73 (30.0%) received endocrinology doctors’ suggestions. After counseling,40 were still in poor glucose control, and 11(27.5%) not followed up the treatment recommendations. Of 102 surgical patients with poor glycemic control, 35 (34.3%) received endocrinology doctors’ suggestions. After counseling,25 were still in poor condition, and 6(24%) not followed up the treatment recommendations.6. The rate of patients having blood glucose test among selective operation patients on the day before operation and two days after operation was 89.6% and 91.2%, respectively. The percentage of blood glucose monitoring on the day before and after the operation was 86.3% and 83.1%, respectively.7. The percentage of selective operation patients with FBG less than 8 mmol/L and 10 mmol/L before the operation was 69.3% and 88.1%. The proportion of patients with FBG less than 8 mmol/L and 10 mmol/L on the third day after the surgery was 62.5% and 77.8%.8.14.1% of the patients had episode of hypoglycemia, and among them, only 57.4% retested their blood glucose after the treatment of hypoglycemia.9. The prescription for outpatients has many deficiencies. Less than 25% of the patients were asked to pay clinical visits, no more than 5% patients were suggested to see diabetes educators, less than 60% patients had prescription concerning their blood glucose, and only 50% patients brought insulin needles when they were discharged.Conclusion:1. The prevalence of inpatients with diabetes in 3-A hospitals in Nanjing was high, The majority of diabetes patients were in the departments other than endocrinology department. So, it was necessary to improve management of blood glucose in hospitals.2. The rate of HbAlcchecking of inpatients was low, especially in surgery patients. It was necessary to emphasize the importance of HbAlc checking.3. The glycemic control of inpatients in 3-A hospital in nanjing was poor, and the percentage of endocrinology department counseling was low.4. The blood glucose mornitoring during perioperative period was relatively satisfying, but the level of glycemic control remained to be further improved.5. There was a gap between the clinic practice and the standard guideline in the treatment of hypoglycemia.6. Blood glucose related treatment was poor, therefore, it should be emphasized when discharge a patient with diabetes. |
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