Surveillance of diabetes with inpatients on glucocorticoids: are the JBDS audit standards being met?

Abstract

Glucocorticoids (steroids) are widely prescribed in hospital inpatients but are known to be associated with the development or worsening of hyperglycaemia. Hyperglycaemia in inpatients is associated with adverse outcomes. The Joint British Diabetes Societies (JBDS) for Inpatient Care have produced guidelines on the management of steroid induced diabetes, or steroid worsened diabetes, but it is unknown how well these are followed. We conducted a single centre cross-sectional survey to assess the prevalence of glucocorticoid use among adult – non-COVID – patients at our institution. We wanted to assess whether glucose measurements were being taken and, if so, how frequently. We found that 59 (6.8%) of our inpatient population were on glucocorticoids. Of these 59, 14 (23.7%) had a previous diagnosis of diabetes, and only 21 (35.6%) had any glucose monitoring during the prior 24 hours. Thirteen of these 21 people (61.9%) had diabetes, and only half of these had glucose monitored at least four times per day. Only 19 of the 59 people on glucocorticoids (32.2%) had had an HbA1c measured in the preceding three months. Our data show that the audit standards set in the JBDS guidelines for management of glucose in people on glucocorticoids were generally not met. More work needs to be done to educate ward staff to improve the care for this potentially vulnerable group. Copyright © 2021 John Wiley & Sons.