ABSTRACT
Background and Aims: Background: Frailty associated with older age increases the risk of complications for diabetes and its treatment, in particular hypoglycaemia. Free Style Libre is a form of flash glucose monitoring that has been commissioned for use in people living with type 1 diabetes who meet NHS criteria and can reduce hypoglycaemia. Aims: Evaluate whether patients ≥65-years-old across Birmingham Heartlands Hospital (BHH) and Solihull Hospital (SOL) are meeting AATD time in range CGM targets. Methods: BHH and SOL patients ≥65-years-old using Free-Style Libre until June 2021 were included in the study population. Patient data such as average scans per day, TIR, TAR, TBR and time <3.0mmol/L were transferred from Libreview. Demographic and HbA1c data were retrieved from electronic patient records. Results: 65 patients were identified, 44 were eligible for inclusion. 68.2% (30/44) met the TIR target of >50%, 45.5% (20/ 44) met the TAR target of <10% and 18.2% (8/44) met the TBR target of <1%. Further analysis of TBR, comparing patients to the AATD recommendation for younger people, found that 75% (33/ 44) spent <4% of time below range. 18.2% (8/44) spent <1% in hypoglycaemia (<3mmol/L) and 81.8% (36/44) spent ≥1% in hypoglycaemia. Conclusions: Despite using Free Style Libre, older patients remain at significant risk of hypoglycaemia. This risk should be managed in outpatient clinics using hypo-awareness and frailty scores. Free Style Libre data can be used as per the ABCD risk stratification criteria for triaging these patients with high risk hypoglycaemia during the COVID-19 recovery phase.
ABSTRACT
Aim: To investigate the prevalence and variations in precipitating causes of diabetes-related ketoacidosis (DKA) across hospitals and types of diabetes across the West Midlands. Methods: All people admitted with DKA from 1 January 2021 and 30 September 2021 in six hospitals in West Midlands as part of DEKODE database were included in this study. Precipitating causes were categorised as: excess alcohol-associated, covid-19 related, drug-induced, inter-current illness, new diagnosis of diabetes, sepsis, SGLT2 inhibitor related, suboptimal compliance to treatment, surgical, and unknown. Results from each of the participating hospitals are reported as frequencies and proportion anonymously. The differences in frequencies of precipitating causes by hospitals and type of diabetes were analysed by Kruskal-Wallis and Mann-Whitney U test respectively. Results: A total of 377 episodes were identified. Overall, inter-current illness (37.4%, n = 141) and suboptimal compliance to treatment (26.8%, n = 101) were the main precipitating causes of DKA. covid-19 contributed to 7.4% of episodes. While there were no significant differences between precipitating causes of DKA in people with type 1 (n = 210) and type 2 (n = 113) diabetes (p = 0.173), we noticed a variation across hospitals (p = 0.035). For example, hospital A had a higher prevalence of inter-current illness (44.4% vs 23.3%) and lower frequency of suboptimal compliance to treatment (18.8% vs 34.3%) compared to hospital B. Conclusion: Intercurrent illness and sub-optimal compliance remain common causes of DKA regardless of diabetes type. The DEKODE database allows rapid analysis of regional DKA data for both research and clinical care.
ABSTRACT
Background: In June 2020, dexamethasone use was approved for hospitalised coronavirus (covid-19) patients in the United Kingdom. Hyperglycaemia in this group has been associated with increased mortality, leading to a national guidance in managing it. Aims: To assess variability in managing hyperglycaemia during dexamethasone therapy and glycaemic outcomes post dexamethasone in covid-19 patients. Method: Retrospective data analysis was performed for 150 dexamethasone-treated covid-19 adult, non-pregnant patients admitted between June and December 2020. We looked at baseline clinical characteristics, adherence to guidance in managing hyperglycaemia and insulin requirement on discharge. Results: Of the 150 patients, 117 (78%) were known to have type 2 diabetes. Of the 27 (18%) not known to have diabetes, 24 had a glycated haemoglobin of 42mmol mol-1 or more, suggesting undiagnosed diabetes and the majority (38%) were White. Prior to dexamethasone, 121 (81%) were not on insulin. After the first dose, 82% had a blood glucose check within 12 hours, 79% had a blood glucose of more than 12mmol l-1 within 24 hours and only 50% had the recommended four times daily blood glucose checks. Of the 121 insulin naive patients, only 52% were managed with the recommended twice daily Neutral Protamine Hagedorn insulin, while 27 (22%) needed insulin on discharge. Of those 27 patients, 44% were White, 26% were Asian and 26% had not declared their ethnicity. Conclusions: Our data show a notable variability in managing hyperglycaemia in dexamethasone-treated covid-19 patients. In this cohort, a high proportion of insulin naive patients required insulin on discharge, suggesting a high risk for progression of diabetes.