| ObjectiveThis study was to investigate the Inpatient Diabetes Management of Immunology Department of Peking Union Medical College Hospital.We aimed to reflect status of Diabetes Management in non-endocrinology department and find out problems of physicians of non-endocrinology department when managing Inpatient Diabetes,thus increase recognization of diabetes management and quality of treatment diabetic patients.Methods1.We collected general information of 91 patients who was diagnosed as diabetes when discharged.2.We research status of Diabetes Management in 4 respects,including blood sugar monitoring,disposing,results and management of diabetes complications.3.The patients were divided to 2 groups according to whether their blood sugar reach the target when discharged.T-test,rank sum test,Chi-square test and Single factor/Multivariate Logistic regression analysis were performed to find out risk factors affecting target rate.4.Using ROC(receiver operating characteristic)curve to find out relationship between target-reaching rate and decreasing level of FBG&PBG.Results1.Of the 91 diabetic patients,39 were male and 52 were female,aging(53±13)years old.50 were diagnosed as diabetes previously(PDM)and 41 were newly diagnosed(NDM).48 were T2DM,42 were Steroid-induced Diabetes Mellitus and 1 were T1DM.16 were seriously sick and 41 were suffered from infection.2.Average hospital stay was(31.64±15.92)days,average monitoring days was(12.94±10.24);The average proportion of monitoring days to hospital stay were 40.92%.63.73%(58/91)of patients had HbA1C checked.3.61.53%(56/91)of patients whose FBG were)7.8mmol/L,42.86%(39/91)were>10mmol/L;93.40%(85/91)of patients whose PBG were>10mmol/L,90.11%were>13.9mmol/L;98.90%(90/91)of patients whose RBG were>10mmol/L,51.64%(47/91)were>20mmol/L.4.Average ratio of days which FBG>7.8mmol/L to total monitoring days were 22.35%,average ratio of days which FBG>10.Ommol/L to total monitoring days were 13.55%;average ratio of days which PBG>10.Ommol/L to total monitoring days were 84.65%,average ratio of days which PBG>13.9mmol/L were 59.23%.5.67.03%(61/91)of patients whose blood sugar was not able to reach the target when discharged.86.81%(79/91)of them whose blood sugar was not able to reach the target when admitted,only 37.97%(30/79)of them reached the target when discharged.6.Of the patients who failed to reach the target(61/91,67.03%),9.83%(6/61)didn' t receive glucose-lowering therapy,31.14%(19/61)were not treated by insulin during hospital stay,and no insulin were was given to 45.90%(28/61)of them when discharged.Moreover,73.78%(45/61)of them haven' t been consulted by Endocrinologist,and 31.14%(19/61)of them were not told to follow up in The Endocrinology department.7.During hospital stay,25.27%(23/91)were suffered from hypoglycemia,69.56%(16/23)of them didn' t receive an adjusted therapeutic regimen.8.70.33%(64/91)of the patients were examined by ultrasonic cardiogram,18.68%(17/91)by Renal artery ultrasound,25.27%(23/91)by carotid artery ultrasound,14.29%(13/91)by lower limb ultrasound,26.37%(24/91)by electromyography,17.58%(16/91)were consulted by ophthalmologist,59.34%(54/91)had 24hUPro checked.9.84.61%(77/91)had serum lipid checked and 46.75%(36/77)reached the target,29.26%(12/41)of those who failed to reach the target haven' t received lipid lower therapeutic regimen.100%(91/91)had their blood pressure monitored and 12.09%(11/91)failed to reach the target,45.45%(5/11)of them haven' t received anti-hypertension therapy.10.Comparing the target-reaching group(30)and the not-reaching group(61),target-reaching group had higher ratio of hypoglycemia,FBG and PBG decreasing level,which were different statistically(P<0.05);lower rate of seriously ill and steroids usage rate,and those received steroid pulse therapy had statistically lower target-reaching rate(P<0.05).Multivariate Logistic regression analysis showed that seriously ill,hypoglycemia,FBG and PBG decreasing level were affecting factors.ROC curve showed FBG decreasing level>=4.35mmol/L,PBG decreasing level>=6.85mmol/L was most beneficial for BG to reach target.Conclusions1.Overall,among the Inpatient Diabetes of immunology department,T2DM and Steroid-induced Diabetes Mellitus were the majority.Ratio of PDM and NDM were nearly the same.Infection percentage were high.2.In terms of blood sugar monitoring,ratio of monitoring days to hospital stay and HbA1C examination rate were low,indicating we should enhance awareness of blood sugar monitoring.3.In terms of blood sugar disposing,patients that didn' t reach target had high ratio of not receiving insulin therapy,endocrine consultant and endocrinology department following up advises,asking for more positive blood sugar disposing therapeutic regiment.4.In terms of blood sugar result,ratio of bad glucose control,numbers of days of hyperglycemia and patients who failed to reach target were high,showing unsatisfied blood sugar control.5.In terms of management of diabetes complications,related examinations were not enough applied.6.For patients who had poor control of blood pressure and serum lipid,a certain number didn' t receive related therapy.7.Seriously ill and steroids usage rate,especially steroid pulse therapy were risk factors for not reaching target;physicians should pay attention to hypoglycemia when controlling blood glucose;both FBG and PBG should be concerned when controlling blood sugar. |
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