Inpatient care for people with diabetes

12 October 2017

• At least one in six of all hospital beds are occupied by people with diabetes. They will tend to be older, sicker, have a longer length of stay and be admitted more often than the general population.
• The National Diabetes Inpatient Audit (NaDIA), 2016, showed that inpatient support (in the form of Diabetes Inpatient Specialist Nurses (DISN), inpatient dietetic support and inpatient podiatry) was not available to people in 28% of eligible sites 
• 1 in 25 people with Type 1 diabetes developed in-hospital DKA due to under-treatment with insulin.
• The proportion of patients experiencing medication management errors has increased since 2011from 23% to 24%.
• Insulin errors were recorded in nearly half of those treated with insulin, 46 % in 2016
• Almost a quarter of hospital sites do not have a Multi-disciplinary Foot Care Team, although this proportion has reduced from 42% in 2011.

Diabetes UK recommends  

Commissioners should: 

• Ensure through their contracts that all healthcare professionals working in hospitals are competent in diabetes care. 
• Ensure that hospitals have a specialist multidisciplinary footcare team that is compliant with NICE guidelines on diabetes footcare. 

Hospitals should: 

• Have a diabetes inpatient specialist team to respond to referrals and provide support and training to generalist staff. Staffing levels should be reviewed by providers to ensure that people with diabetes can access specialist diabetes care when and where needed as seven day working is rolled out. 
• Monitor and review patient safety standards to implement improvements working across all parts of the hospital. This should include recording cases of diabetes-related severe harms on the corporate risk register and sharing evidence of any systems that have successfully reduced the incidence of these. 
• Ensure that everyone with diabetes receives foot checks, foot protection and access to specialist footcare if required during admission and on discharge from hospital. 
• Ensure that their nutrition policies meet the needs of the one in six of their patients who has diabetes. 
• Ensure that people with diabetes are enabled and supported to self-manage their diabetes where appropriate while in hospital