BBIT Background

Diabetes, Obesity & Nutrition SCN

Diabetes in Hospital is Common

Diabetes is a common chronic condition, affecting an estimated 1 in 20 Canadians. It is estimated that the health care budget contributes 13 billion dollars per year to the care of 2 million Canadians living with Diabetes.

Alberta data suggests that 1 in 5 adult patients admitted to hospital(s) in Alberta has diabetes; most patients are not admitted with a diagnosis of diabetes, yet diabetes is the fourth most common co-morbidity in patient charts.

Poor Glycemic Control Results in Poor Outcomes

In Alberta, patients with diabetes stay in hospital 40% longer than their counterparts without diabetes (3 days versus 5 days during the 2014/15 fiscal year).

If clinicians fail to recognize and treat hyperglycemia appropriately, patients with diabetes are at risk for:

  • multi-organ complications
  • infection
  • prolonged hospitalization
  • increased mortality

Hyperglycemia in hospital has been associated with a poorer prognosis in medical and surgical patients, regardless of age, gender or type of diabetes. Literature has demonstrated poorer outcomes in patients with a wide array of medical and surgical conditions, ranging from:

  • stroke
  • acute coronary syndrome
  • COPD exacerbation and community acquired pneumonia to trauma
  • stem cell transplantation
  • wound healing following surgery
  • others

Improving Glycemic Control Improves Outcomes

Improving glycemic control in hospital has been associated with shorter length of stay in hospital and decreased rates of readmission, which in one study resulted in substantial cost-savings of $1500 per patient. Moreover, in a second study, implementing programs focused on treating hyperglycemia led to as much as a 450% return on investment.

Data from our early adopter sites in Alberta has demonstrated that using a knowledge translation approach to implement BBIT protocols in hospital has resulted in improved rates of hyperglycemia without increasing the rate of hypoglycemia. Length of stay was reduced by 10-14%.

Diabetes Canada recognizes that patients with diabetes have complex needs while in hospital and that the acuity of their illness, nutritional intake and activity are difficult to predict and treat appropriately. Diabetes Canada has recommended clinical practice guidelines for diabetes management in hospital. These recommendations include:

  • blood glucose targets of 5 to 10 mmol/L for most patients who are admitted to hospital. These targets are higher and more flexible than the typical targets for patients with diabetes who are well at home due to their complex needs while in hospital.
  • the use of a scheduled subcutaneous basal bolus insulin regimen in favour of a subcutaneous sliding scale insulin regimen. Basal bolus insulin regimens better replicates physiologic insulin release to support glycemic management.
  • the development and implementation of organizational policies and order sets to support glycemic management in acute care settings.
  • supporting patients with diabetes in the self-management of their diabetes care needs when safe and appropriate.