[Evaluation of the hospital management of insulin-dependent diabetics]

Abstract

Objective: There is a known relationship between blood glucose control and development or progression of complications in diabetes mellitus. The aim of our study was to assess the quality of hospital care in patients with insulin-dependent diabetes.

Patients and methods: A prospective study was conducted over a 6-month period (April 95-September 95) to perform a clinical audit comparing results obtained with care standards. The study group included 257 consecutive patients (age range 15-39 years) who consulted the hospital outpatient clinic of were hospitalized for insulin-dependent diabetes mellitus

Results: Results differed depending on the care standards used for comparison. There were 45 patients (17%) who consulted 4 times or more; 43% of the patients were not hospitalized and 32% did not had a fundus examination during the preceding year. There was a 51% deviation from the standard number of capillary blood glucose measurements and 72% of the patients stated they adapted their insulin dose. Mean glycosylated hemoglobin level (HPLC method) was 9.78 +/- 2.37% (standard = 7%).

Conclusion: This assessment of hospital care demonstrated a deviation of medical surveillance from standard care. More frequent consultations would help improve patient information. It is important to recall that an annual hospitalization and rigorous application of clinical surveillance with annual fundus examination are essential. Information provided by physicians, nurses and dietitians should be an integral part of hospital care. Likewise, it is undoubtedly useful to provide psychological counselling for diabetic patients. A reassessment should evaluate the impact of such recommendations in order to determine the impact, in terms of reduced mortality, of improved hospital care.