An audit of diabetes care in three district general hospitals in Cardiff

Abstract

Our objective was to determine the overall prevalence of diabetes in three district general hospital inpatient populations and to compare the level of diabetes care provided, using a modification of guidelines recommended by the British Diabetic Association. The survey involved completing a standard proforma of all inpatients in the three district general hospitals in Cardiff on two separate occasions. We identified 104 diabetic patients from a total of 1,220 inpatients from the first survey, and 103 diabetic patients from of 1,236 inpatients from the second survey. The data from both groups of diabetic patients were pooled for analysis. The mean age was 64.8 years with an even sex distribution. The percentage of hospital inpatients who had diabetes was 8.4%. Diabetes was the main cause of hospital admission in 58% of cases, with the majority of patients requiring management of the long-term vascular complications of diabetes. The mean duration of stay of diabetic inpatients at the time of the survey was 16 days. In more than half of all patients with diabetes, no record of examination of the feet for ulceration (56%) or the lower limbs for peripheral pulses (54%) was found. In 66% of cases, no record of fundoscopy was present and mydriasis was carried out in fewer than 15% of these cases. Visual acuity was not measured in 85% of cases. Measurement of glycated haemoglobin was performed in less than 40% of cases whilst approximately 75% of cases had no measurement of blood lipids recorded. Half of the patients with diabetes had not seen a hospital dietitian at the time of the survey. Only 44% of cases had a specific diabetes follow-up plan recorded. This audit has identified several important deficiencies in the medical care of patients with diabetes in three district general hsopitals in South Wales. These are considered to be representative of other hospitals in the United Kingdom and this study emphasises the importance of strategies to improve and co-ordinate diabetes care in the secondary sector.