The Management of Hospital In-patients with Diabetes Mellitus

Dhatariya, Ketan (2017) The Management of Hospital In-patients with Diabetes Mellitus. Doctoral thesis, University of East Anglia.

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In the UK, the prevalence of diabetes in adults in the general population is currently reported as just over 6% in 2014-15 [1]. This rose from a prevalence of 5.5% in 2010. However, the most recent data from the 2016 United Kingdom National Diabetes In-patient Audit reported that the prevalence of diabetes amongst hospitalised in-patients was 17% [2]. This represented a rise of over 15% since the
first National Diabetes In-patient Audit was carried out in 2010, and was the same rise in prevalence seen in the general population during that time. Thus diabetes is disproportionately over represented in the in-patient population.
It has been recognised for many years that in-patients with diabetes experience ‘glucose-related’ harms. Any form of dysglycaemia is associated with increased harms – in terms of poor outcomes (however that is defined) and also increased mortality [3].
For many years it was well recognised that having long term high glucose concentrations was associated with an increased risk of developing the long term micro and macrovascular complications of diabetes. It was only with the publication of the two seminal trials, the Diabetes Control and Complications Trial in type 1 diabetes and the United Kingdom Prospective Diabetes Study in type 2 diabetes that showed conclusively that in an outpatient population tight glycaemic control was associated with a reduced risk of developing those complications [4,5]. However, to date whilst there are a great deal of data to show that high glucose concentrations are associated with harm in hospitalised in-patients with diabetes, there are almost no data to show that improving glucose concentrations is associated with benefit. However, most authorities agree that glucose concentrations between 6.0 and 10.0mmol/l (with an acceptable range of 4.0 to 12.0mmol/l) are likely to be most beneficial (or rather, least likely to be associated with harm).
In the UK there is an organisation called the Joint British Diabetes Societies for Inpatient Care group (JBDS), of which I am a senior member. JBDS is a group of professionals interested in the care of in-patients with diabetes. This group, which is funded by Diabetes UK and the Association of British Clinical Diabetologists and is a collaboration between these two national organisations and the National Diabetes Inpatient Specialist Nurse Group, had as it’s ‘mission statement’ the focus on producing evidence based or, where this was not possible, consensus based, clinical guidelines for the management of diabetes in hospitalised in-patients. These guidelines were designed to be used by non-specialists, and written in a user friendly way to make them clinically useful.
I have been involved in writing or contributing to most of the guidelines produced by the group, and have been the lead author on two of the most widely read / used documents – peri-operative care and diabetic ketoacidosis. Indeed, as a result of my involvement in these writing groups, I am now recognised as an international expert on these two subjects. I am regularly invited to speak on these subjects, but also
invited to write about them as well.
This thesis is a journey through various aspects of my involvement in in-patient care for patients with diabetes from the time I was first appointed as a consultant in Norwich in 2004 to the spring of 2017. In particular my hypothesis is that because of the work I and others have published, the management of in-patients with diabetes has improved the care of this vulnerable group.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Users 2593 not found.
Date Deposited: 08 Nov 2017 09:56
Last Modified: 08 Nov 2017 09:56

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