Audit of Inpatient Monitoring and Management of Hypoglycemia in Diabetic Patients Compared to National Guidelines
DOI:
https://doi.org/10.53350/pjmhs02025193.6Keywords:
Hypoglycemia management, inpatient diabetes care, clinical audit, guideline adherence, blood glucose monitoringAbstract
Background: Hypoglycemia is a serious and preventable complication in hospitalized diabetic patients, often resulting from treatment with insulin or insulin secretagogues. Effective inpatient monitoring and timely intervention are crucial for minimizing adverse outcomes.
Aims: To evaluate current inpatient practices for monitoring and managing hypoglycemia in diabetic patients at Lady Reading Hospital, Peshawar, and to compare these practices with National Guidelines for Management of Hypoglycemia in Hospitalized Patients.
Methods: A clinical audit was conducted from July to December 2024, reviewing 150 diabetic patient records with at least one hypoglycemic episode (blood glucose <70mg/dL). Data were collected using a structured proforma aligned with national standards and analyzed using SPSS v25.0. Parameters assessed included monitoring frequency, timeliness of treatment, reassessment, documentation, and preventive strategies.
Results: A total of 212 hypoglycemic episodes were recorded. While blood glucose rechecking within 30 minutes post-treatment showed 81.1% compliance, timely treatment initiation within 15 minutes was noted in only 33.5% of cases. Preventive measures and care escalation were documented in just 42% and 29.3% of cases, respectively.
Conclusion: Although some aspects of hypoglycemia management at LRH show acceptable adherence to guidelines, significant gaps remain, particularly in early intervention and documentation of preventive strategies.
References
Lima, J. E., Moreira, N. C., Sakamoto-Hojo, E. T. J. M. R. G. T., & Mutagenesis, E. Mechanisms underlying the pathophysiology of type 2 diabetes: From risk factors to oxidative stress, metabolic dysfunction, and hyperglycemia. 2022; 874, 503437.
Jadon, A. S., Kaushik, M. P., Anitha, K., Bhatt, S., Bhadauriya, P., & Sharma, M. Types of diabetes mellitus, mechanism of insulin resistance and associated complications. In Biochemical immunology of diabetes and associated complications 2024; (pp. 1-18): Elsevier.
Azeem, S., Khan, U., Liaquat, A. J. A. O. M., Surgery. The increasing rate of diabetes in Pakistan: A silent killer.2022; 79.
Akhtar, S., Ali, A., Asghar, M., Hussain, I., Sarwar, A. J. B. o. Prevalence of type 2 diabetes and pre-diabetes in Sri Lanka: a systematic review and meta-analysis. 2023; 13(8), e068445.
Husain, K. H., Sarhan, S. F., AlKhalifa, H. K. A. A., Buhasan, A., Moin, A. S. M., & Butler, A. E. J. I. J. o. M. S. (2023). Dementia in diabetes: the role of hypoglycemia. 24(12), 9846.
Munugoti, S., Reddy, G., Singh, R., Kakarlapudi, M., Muralidhara, S., Rosenfeld, C. J. E., & Science, M. Diabetes-related hypoglycemia, contributing risk factors, glucagon prescriptions in two community hospitals. 2024;15, 100178
Hölzen, L., Schultes, B., Meyhöfer, S. M., Meyhöfer, S. Hypoglycemia unawareness—a review on pathophysiology and clinical implications. Biomedicines, 2024; 12(2), 391.
Lupaescu, A. V., Iavorschi, M., Covasa, M. The use of bioactive compounds in hyperglycemia-and amyloid fibrils-induced toxicity in type 2 diabetes and Alzheimer’s disease. Pharmaceutics, 2022; 14(2), 235.
Gerwer, J. E., Bacani, G., Juang, P. S., &Kulasa, K. Electronic Health Record–Based Decision-Making Support in Inpatient Diabetes Management. Current diabetes reports, 2022; 22(9), 433-440.
Demidowich, A. P., Stanback, C., &Zilbermint, M. Inpatient diabetes management. Annals of the New York Academy of Sciences, 2024; 1538(1), 5-20.
Torres Roldan, V. D., Urtecho, M., Nayfeh, T., Firwana, M., Muthusamy, K., Hasan, B., Murad, M. H. A systematic review supporting the endocrine society guidelines: management of diabetes and high risk of hypoglycemia. The Journal of Clinical Endocrinology & Metabolism, 2023; 108(3), 592-603.
Willis, T. A., Wood, S., Brehaut, J., Colquhoun, H., Brown, B., Lorencatto, F., & Foy, R. Opportunities to improve the impact of two national clinical audit programmes: a theory-guided analysis. Implementation Science Communications, 2022; 3(1), 32.
Dickerson, J. E. Clinical audit, quality improvement and data quality. Anaesthesia & Intensive Care Medicine, 2023;24(8), 486-489.
Thabit, H., & Schofield, J. Technology in the management of diabetes in hospitalised adults. Diabetologia, 2024; 67(10), 2114-2128.
Law, K. K., Coyle, D. H., Neal, B., Huang, L., Barrett, E. M., Arnott, C., Wu, J. H. Protocol for a randomized controlled trial of medically tailored meals compared to usual care among individuals with type 2 diabetes in Australia. Contemporary Clinical Trials, 2023; 132, 107307.
McCall, A. L., Lieb, D. C., Gianchandani, R., MacMaster, H., Maynard, G. A., Murad, M. H., Wiercioch, W. Management of individuals with diabetes at high risk for hypoglycemia: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 2023; 108(3), 529-562.
Demidowich, A. P., Stanback, C., & Zilbermint, M. Inpatient diabetes management. Annals of the New York Academy of Sciences, 2024; 1538(1), 5-20.
Sreedharan, R., Khanna, S., & Shaw, A. Perioperative glycemic management in adults presenting for elective cardiac and non-cardiac surgery. Perioperative Medicine, 2023;12(1), 13.
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Copyright (c) 2025 Sundas Safdar, ZEESHAN UMAR, HAFSA WAQAR, SYED HASSNAIN SHAH, SALIHA WAZIR, HAZRAT ULLAH

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