Inpatient Glycemic Care In A Department Of Cardiology Of A University Hospital In Dalian

Background: Diabetes is highly prevalent in China,the number of cases accounts about 110 million people.The prevalence of prediabetes reaches as high as 50.1% in population old than 18 years old.Hyperglycemia is an independent risk factor for cardiovascular events.Therefore,management of dysglycemia to decrease its comorbidity in patients with cardiovascular disease is of importance.The current state of glycemic care in inpatient other than endocrinological unit is not clear.Thus it is important to delineate the current state of detection and treatment of dysglycemia in patients hospitalized in department of cardiology in order to improve the care of those patients with diabetes.Objective : To study the presence and management of prediagnosed,newly diagnosed diabetes in a university cardiology unit in the year of 2013.Methods: Clinical data of 4290 patients admitted to the cardiology unit in the year of 2013.Clinical data included age,sex,history of diabetes,way of admission,FPG,2h PG,Hb A1 c,endocrine specialist consultation,glycemic medication and MBG.SPSS(IBM,ver 20)was use for statistical analysis.A P value of less than 0.05 was considered statistically significant.Results:1.Data of 4290 cases(49.6% male),age(64.1+12.8)years old were retrieved;816 cases(19.0%)were admitted from the emergency room,3474 cases(81.0%)from outpatient unit.2.History of diabetes were found in 1041 cases(accounted 89.3% of all diabetic patients),125 cases(10.7%)were newly diagnosed with diabetes after admission according to FPG.The ratio of patients with history of diabetes admitted from outpatients was significantly higher than newly diagnosed diabetes(X2=44.259,P<0.001).A total of 1166 cases(27.2% of all patients admitted)received Hb A1 C examination 27.2%,and 4211 cases(98.2%)FPG screened 98.2%,and only 228 patients(5.3%)received 2h PG screening.For those who had a history of diabetes 523 patients received Hb A1c(50.2%)examination,1021(98.1%)had their FPG checked,31(3.0%)had their 2h PG checked,and 619 patients(59.5%)received MBG;For those newly diagnosed diabetic patients after admission,85 patients(68.0%)received Hb A1 c,75 cases(60.0%)had their 2h PG checked,MBG was ordered in 61 cases(48.8%).A borderline higher ratio of patients with newly diabetes received Hb A1 c examination than patients with history of diabetes(X2=4.069,P=0.053),a significantly higher ratio of 2h PG examination in newly diagnosed diabetes than those with history of diabetes(X2=264.281,P<0.001),and a nonsignificant ratio of MBG ordered in patients with history of diabetes versus those with newly diagnosed diabetes(X2=1.451,P=0.262).3.A total of 329 cases(28.2% of all patients with diabetes)received endocrinologist consultation,242 cases were patients with history of diabetes,and 87 cases were newly diagnosed(X2=52.127,P<0.001).231 examinations of Hb A1 C examination,227 cases received MBG were ordered after consultation.For those who had a history of diabetes 171 patients(70.7%)received Hb A1 C examination,240(99.2%)had their FPG checked,18(7.4%)had their 2h PG checked,and 174 patients(71.9%)received MBG;For those newly diagnosed diabetic patients after admission,60 patients(69.0%)received Hb A1 c examination,52(60.0%)had their 2h PG checked,MBG was ordered in 53 cases(60.9%),and all of them had their FPG checked.4.There were 1409 cases that hospitalized due to the risk of CHD(coronary heart disease)(32.8%),418 cases received examinationfor Hb A1C(29.7%),1386 cases for FPG(98.4%),64 cases for 2h PG(4.5%).566 cases(with history of diabetes and newly diagnosed diabetes,40.2%)had diabetes for patients with coronary heart disease patients.37.2% had history of diabetes,and 3.0% were newly diagnosed in 42 cases.142 cases(25.1 %)received consultation,114 cases(21.8%)were patients with history of diabetes,and 28 cases(66.7%)were newly diagnosed.5.3124 cases of undiagnosed diabetes in 59 cases not detected FPG,there are 348 cases of FPG values greater than or equal to 6.1mmol/L,but did not check 2h PG and Hb A1 C.6.For patients with history of diabetes,102 cases(9.8%)did not receive treatment.of those without treatment,48 patients had a FPG level more than 7mmol/L(47.1%).For those had history of diabetes and receive treatment,46 patients(4.4%)received traditional Chinese medicine(alone or with other drugs),432 patients(41.5%)received insulin,of with insulin 189 cases(18.2%)received insulin alone,243 patients(23.3%)received combination of insulin and OAD;272 patients received single OAD(26.1%).For patients with OAD,166 patients took acarbose(61.0%),metformin 56 cases(20.6%),insulin secretagogues(sulfonylurea or non-sulfonylurea).50 cases(18.4%),took dual combination OAD,and 165 cases received triple OAD(15.9%).The more often usedcombination were metformin and acarbose(36.4%),acarbose and insulin secretagogues(32.3%),19 patients(1.8%)received triple oral medication withmost often of combination of insulin secretagogues,metformin,and acarbose.For those with newly diagnosed diabetes,no one received traditional Chinese medicine,108 patients received hypoglycemic therapy(86.4%),of which 19 patients were treated with insulin,(15.2%),10 cases of insulin alone(8.0%),9 patients with combination of insulin with OAD(7.2%).68 patients(54.4%)received OAD only therapy,and of which,acarbose in 54 cases(79.4%),metformin in seven cases(10.3%),insulin secretagogues in 7 cases(10.3%),dual OAD in 21 cases(16.8%),of which 11 patients with acarbose and metformin combination(52.4%),5 cases(23.8%)acarbose and insulin secretagogues,and 5 cases(23.8%)in metformin and insulin secretagogues combination.Conclusion: Patients admitted in cardiology unit did not receive enough attention for glucose control: dysglycemic screening,monitoring,endocrinologist consultation,and hyperglycemic management.