Poster Presentation The Annual Scientific Meeting of the Australian Diabetes Society and the Australian Diabetes Educators Association 2013

Investigating clinical inertia in the management of patients with type 2 diabetes mellitus in St Vincent’s Hospital Melbourne (#365)

Alice Hong 1 , Stewart Cockram 2 , Bridey Wood 2 , Kathleen Steele 3 , Richard MacIsaac 3
  1. Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
  2. Department of Pharmacy, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
  3. Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia

Background:  Hospitalisation represents an important opportunity to assess and improve glycaemic control in patients with T2DM.  Therefore, it is important to identify clinical inertia (a failure to intensify therapy in patients with poorly controlled diabetes) in optimising inpatient diabetes management.

Aim: To examine the assessment of long-term glycaemic control as determined by HbA1c testing in patients with T2DM admitted to a tertiary referal centre, and evaluation of appropriate medication interventions in the setting of suboptimal glycaemic control.

Method: Cohort was identified by review of discharge medications. Patients were included if discharged on at least one glucose lowering medication with a diagnosis of T2DM.

The cohort was analysed to determine:

-          Whether HbA1c was checked (or available from a time period of no greater than three months prior to admission)

-          Numbers of cases determined to have poor control (defined as HbA1c ≥8%)

-          Rates of glucose control medication change during admission if HbA1c was ≥8%

Results:  653 patients were identifed between September to December 2012. A recent HbA1c was available for 297 patients (45.5%). For these patients, 108 (35.4%) had a HbA1c level ≥8% and of these patients only 63 (58.3%) had their glucose lowering medications altered.

Conclusion: Our study shows that less than half of patients admitted to our hospital with T2DM had their long-term glycaemic control assessed via HbA1c testing. Of those identified with poor glycaemic control, approximately 40% did not have any changes made to their glucose lowering medications. Greater awareness of clinical inertia in the management of T2DM is required to improve glycaemic control in hospitalised patients.