National Diabetes Inpatient Audit England & Wales 2012

The National Diabetes Inpatient Audit for England & Wales for 2012 hit the press at the end of June with the strapline of ‘shocking failings in hospital care’. Diabetes UK led with the finding that, in the five-day period of the audit in September 2012, over sixty people with diabetes developed diabetic ketoacidosis (DKA). Whilst this is clearly not good, at least it is understandable, given that concomitant illness is a common factor in the development of DKA (and presumably the inpatients were all unwell). More worrying to me were the high levels of hypoglycaemia (‘hypo’) since these would have been iatrogenic, that is, caused by excessive drug administration and/or lack of nutrition, and therefore, be attributable to hospital staff.

Around 20% of inpatients experienced a ‘mild hypo’ (defined as blood glucose between 3.0 – 3.9mmol/L) and 10% had a severe episode (<3.0mmol/L). The highest proportion of hypos occurred overnight and 2% of them required injectable treatment. What will the numbers be next week when the new intake of junior doctors take to the wards?

Many Acute Trusts in England (and Healthboards in Wales) seem to think that forking out £20,000-plus for THINKGLUCOSE will solve these problems. But aside from the rather unsavory thought of one part of the NHS having to pay another for patient safety materials, it misses the point that ring-fencing staff time for diabetes education is the major issue. In hospitals around the UK, diabetes teams complain that their attempts to up-skill healthcare professionals are thwarted by last minute withdrawals due to staff shortages on the wards. Until this is met head-on, we will continue to see high-profile disasters on programmes such as ‘Week in, week out’ (‘Wales’s Diabetes Disgrace’ 2012) and massive pay-outs will stretch already limited NHS funds.

Professor Steve Bain