Gaps in Glycaemic Monitoring and Underuse of Cardioprotective Glucose-lowering Agents: Challenges of inpatient diabetes care identified by EFIM's Diabesity Day Survey 2024.

Abstract

People with diabetes and obesity have an increased risk of hospitalisation and in-hospital complications. Rising prevalence of diabetes and obesity, including their co-occurrence, "diabesity", make guideline-compliant treatment increasingly important. However, evidence on specific in-hospital diabesity treatment is limited. We aimed to characterise inpatients with diabetes/diabesity and evaluate their in-hospital care to identify challenges in inpatient diabetes/diabesity management. Cross-sectional data was collected from patient records and ward charts. We analysed differences between inpatients with and without diabesity and explored in-hospital diabetes treatment. We further compared inpatients with type 2 diabetes who started insulin treatment or received cardioprotective glucose-lowering agents to those who did not and used logistic regression to identify predictors of insulin initiation and use of cardioprotective agents. We included 207 people with diabetes from eight European hospitals, 50 % with diabesity. Most inpatients had a HbA1c >6.5 % (48 mmol/mol). Among inpatients with type 2 diabetes, one third did not have a recent HbA1c reading, blood glucose levels were monitored <3 times daily, and only 40 % of those with cardiovascular/renal disease received cardioprotective therapies. HbA1c, creatinine and at-home medications predicted insulin initiation, while admission cause and BMI predicted use of cardioprotective agents. We observed an underuse of cardioprotective glucose-lowering therapies, low rates of glycaemic monitoring, and low availability of HbA1c readings, concluding that clinical guidelines are not sufficiently implemented in everyday practice in Europe. Based on this, we advocate for better staff training, involvement of diabetologists, and raising awareness of the benefits of cardioprotective agents in the hospital.