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Diabetes UK: findings from the 2010 National Diabetes Inpatient

People with diabetes account for 15 per cent of inpatients in England, according to an audit published today by NHS Diabetes.

Analysing clinical data of over 12,000 inpatients with diabetes from 206 hospitals as well as nearly 5,000 patient questionnaires, the 'National Diabetes Inpatient Audit (NaDIA) 2010 (England)' also found that at the time of the audit people with diabetes had been in hospital for an average of eight days, approximately three days longer than all inpatients. Nearly all (86.7 per cent) were admitted as an emergency.

The audit also discovered that over one third (37.1 per cent) of inpatients with diabetes experienced at least one medication error, a quarter (26.0 per cent) of their charts had prescription errors and a fifth (20.0 per cent) had one or more medication management errors. Insulin overdoses can result in potentially fatal hypoglycaemic episodes ('hypos')1 and insufficient insulin can lead to diabetic ketoacidosis (DKA)2 which, if left untreated, can also prove fatal. The audit found that patients with medication errors had twice the rate of severe hypoglycaemia (18.1 vs 7.9 per cent). Of further concern, whilst in hospital 44 people (0.4 per cent) developed DKA and 266 (2.4 per cent) had hypoglycaemia severe enough to require injectable treatment.

Other findings from the results, which were analysed by data experts at Diabetes Health Intelligence, a strategic programme of Yorkshire and Humber Public Health Observatory, found:

. 31.0 per cent of sites had no inpatient diabetes specialist nurses.

. 69.4 per cent of inpatients with diabetes had not been seen by a member of the diabetes team.

. 54.4 per cent of those with a diabetes management problem had seen the diabetes team.

. Only 27.5 per cent of patients had their feet examined at any time during admission.

. 2.2 per cent developed a new foot complication during their hospital stay but 49.6 per cent of these had no input from a Multi-Disciplinary Footcare Team (MDFT)

. 27.2 per cent reported that choice, and 22.7 per cent timing, of meals was only sometimes or rarely suitable for managing their diabetes effectively. People who reported poor choice and timing of food were more likely to have a severe hypoglycaemic episode whilst in hospital.

Anna Morton, Director of NHS Diabetes, said: "The National Diabetes Inpatient Audit highlights all the great work done by expert specialist teams to support diabetes care in hospital every day of the year. The fact that staff in so many Trusts have taken the time to complete the audit is a fantastic achievement and shows just how passionate those delivering diabetes care are. However, the audit also provides evidence that more needs to be done to reduce the variation in the quality of diabetes inpatient care across the country as required by the new NICE Quality Standards for diabetes. All of us working in diabetes care now have a responsibility to act on the findings of this audit."

The audit's clinical lead Dr Gerry Rayman, National Clinical Lead for Inpatient Diabetes, said: "Hospital teams throughout the country have valiantly completed this survey on top of their day jobs in order to gain this valuable piece of evidence. These teams want to deliver better care but need support from their hospital management. In many cases diabetes teams have been both under-staffed and under-resourced, but the results should provide the evidence needed to make the case for improved and dedicated inpatient diabetes services."

Diabetes UK supported the audit by helping to carry out the patient surveys and advising on the questions. Barbara Young, Chief Executive at Diabetes UK, said: "Sadly, this audit provides yet more evidence of an NHS struggling to cope with the growing health challenge of diabetes. We are very concerned that at a time when diabetes is on the increase we are seeing a decrease in the number of diabetes specialist nurse posts. This is a false economy that harms patient care. Specialist diabetes professionals can reduce costs in the NHS by managing complications more effectively and in turn reduce hospital stays and re-admissions.

"Better long-term support of people with diabetes in primary care would also prevent many of these hospitals admissions and free up valuable and ever-tightening NHS resources. We welcome the Government's commitment to provide more support to help people with long term conditions but real investment and action, not rhetoric, has to now be taken to provide universal high quality care across the country."

The Royal Devon and Exeter NHS Foundation Trust has made improvements to its diabetes services on the back of carrying out the audit. Marie Dougal-Johnson, Diabetes Specialist Nurse at the trust, said: "We, as a specialist diabetes department, were under no illusion that this would create a huge amount of work for us, but recognised the audit as a useful tool to assist us to identify our Trusts ways of working regarding patients with diabetes during hospital stays.

"The audit identifies that patients with diabetes, stay in hospital longer than patients without this condition, therefore as the Trust is always looking for ways to improve quality of care for all patients, including the prevention of long stays and increased complications for patients with diabetes, we chose to participate."

ENDS

Note to Editors

. A copy of the summary report (embargoed until 00:01 on Friday) is attached to this email. Copies of the full report will be available to the public on the NHS Diabetes website from Friday (www.diabetes.nhs.uk).

. For more information contact Oliver Jelley on 07766 990 848, email oliver.jelley@diabetes.nhs.uk or Fraser Woodward on 07900 227 668, email fraser.woodward@dakc.nhs.uk.

. Dr Gerry Rayman and Anna Morton are available for interview on Thursday, March 31, and Friday, April 1.

. NHS Diabetes is a national organisation working to improve the quality of care for people with diabetes. We act as an expert resource and support team to help health professionals implement evidence based good practice which both improves outcomes and reduces costs. Regionally, we are transforming diabetes services by working with more than 70 health providers and commissioning organisations to deliver more for less. Nationally, we help develop and implement clinical standards and guidelines to improve diabetes care.

. For more information on the work of NHS Diabetes, visit our website at www.diabetes.nhs.uk.

. Diabetes UK is the leading charity for over 3.5 million people in the UK with diabetes In 2011, Diabetes UK aims to spend over £6 million on diabetes research to investigate the causes and prevention of diabetes, to improve care and treatment of diabetes and ultimately to work towards a cure. For more information visit www.diabetes.org.uk. In the UK, there are currently 2.8 million people diagnosed with diabetes and it is estimated that 850,000 people have Type 2 diabetes but do not know it.

. Diabetes Health Intelligence (a strategic programme of Yorkshire and Humber Public Health Observatory) have a commitment to support the professional diabetes community by providing timely, quality assured national diabetes health intelligence. They are part funded by NHS Diabetes to analyse and interpret the kind of facts, figures and other intelligence that will help to improve the health of people with diabetes. For more information visit www.yhpho.org.uk.

1 Hypoglycaemia (or a 'hypo') occurs when the level of glucose in the blood falls too low. If left untreated the person having a hypo might, eventually, become unconscious. When a hypo happens the person often experiences 'warning signs', which occur as the body tries to raise the blood glucose level. These 'warning signs' vary from person to person but often include feeling shaky, sweating, tingling in the lips, going pale, heart pounding, confusion and irritability. In extreme cases hypoglycaemia can lead to coma and can sometimes prove fatal.

2 In the short term, consistent high blood glucose levels can lead to a condition called diabetic ketoacidosis (DKA). This happens because there's not enough insulin to allow glucose to enter the cells where it can be used as energy. The body begins to use stores of fat as an alternative source of energy, and this in turn produces an acidic by-product known as ketones. Ketones are very harmful and the body will immediately try to get rid of them by excreting them in urine. Consequently, when ketones are present and blood glucose levels are rising, people often become increasingly thirsty as the body tries to flush them out. If the level of ketones in the body continues to rise, ketoacidosis develops (ketoacidosis means acidity of the blood, due to an excess of ketones in the body). Their harmful effect becomes more apparent, and nausea or vomiting may start. In addition, the skin may become dry, eyesight blurred and breathing deep and rapid. Unfortunately, because of vomiting, the body becomes even more dehydrated and less efficient at flushing out the ketones, allowing levels to rise even faster. As the level of ketones rise, it may be possible to smell them on the breath - often described as smelling like pear drops or nail varnish. Eventually, if untreated, the level of ketones will continue to rise and, combined with high blood glucose levels, a coma will develop which can be fatal. However, at any of these intermediate stages, ketoacidosis can be treated and damage usually limited. Obviously, the sooner, the better.

Fraser Woodward
Communications Director
NHS Diabetes and Kidney Care
M: 07900 227 668

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