Enhancing diabetes inpatient care: the momentum increases

reactive. A hospital ward recognises there is a problem with a patient’s diabetes care (who has often been admitted with a diagnosis unrelated to their diabetes) and summons specialist help. The problem with this approach is several fold. Firstly, it relies upon a ward recognising there is a problem. Many hospital health care professionals still do not recognise the relationship between good glycaemic control and improved wound healing rates, quicker resolution of sepsis and other conditions that rely upon phagocyte function. Secondly, if the specialist team are contacted for advice it is often too late, several days after admission when metabolic control could have been targeted earlier with more clinical impact. Thirdly, these patients with diabetes often have other unrecognised diabetes related comorb idities that could have benefited from diabetes specialist review. Fourthly, many of these patients may have been on intravenous insulin sliding scales unnecessarily (potentially delaying discharge from hospital, increasing costs and the need for nursing support), experienced unnecessary hypoglycaemic episodes and be exposed to drug errors that could have been avoided (incorrect type and timing of insulin being particular favourites). All of these problems impact upon quality of care, costs of hospital care and delay hospital discharges. The magnitude of this problem should not be underestimated since 15–20% of inpatients have concomitant diabetes. Given the above observations, it is heartening to see that there is growing recognition of the value of prospective diabetes inpatient care at a national level through NHS Diabetes, Diabetes UK and other organisations. This has arisen with the results of a number of studies which have clearly demonstrated the benefits of prospective diabetes specialist involvement. The article by Andrew Brooks and colleagues (page xxx) continues to support this approach with an average reduction in length of stay exceeding five days per patient with diabetes (with a primary diagnosis of diabetes) and significant reduction in prescription and management errors through multi-professional twice-weekly whole hospital visits. Thankfully, wider recognition and value of this approach towards inpatient diabetes care are emerging within the NHS and our own department were recently awarded the National Winners, NHS Health and Social Care Awards 2010, for our prospective diabetes hospital service. At a time when hospital capacity is severely stretched over winter months, diabetes specialist teams can have an important role to play in diabetes care, improving care quality and also impacting upon duration of hospital stay. All hospital diabetes teams should now be given the opportunity to provide this prospective care with dedicated time to deliver this service. The evidence is unequivocal.