Evaluation of the in-hospital drug policy adopted for the control of diabetes mellitus

Abstract EN

Aim : to assess the degree of Control of diabetes mellitus (DM) by treatment in hospital in adult patients and to assess the therapeutic protocols in current use.

Design : Patients data analysis.

Setting :_Diabetic patients admitted to the medical wards of Tahreer hospital over 8 months August 2001- Marc 2002.

Main outcome measure : Normalistion of the value of blood glucose (BG) on discharge from hospital to figures equals or below 100mg / 100ml.

BG between 100-150 mg / 100ml is a second outcome.

Results : 176 diabetic patients were admitted during the study period, these were 96 males (54.5 %).

Indications for admission were: concurrent illness (es) in 110 (62.5 %), for the control of DM in 46 (26.1 %), for diabetic keto-acidosis (DKA) in 14 (7.91 %) and for hypoglycemia in 6 patients (3.4 %).The mean duration of hospital stay was 4.85 days (1-14 range) Their mean age was 56.9 years(Range 15-80).

The BG on admission ranged between 40-512 mg / 100ml with a mean of 254.9 mg / IOOml .The BG on discharge was 80-460 mg / 100ml with a mean of 153 mg / IOOmt.

BG was below or equal to 100mg / 100ml on discharge in 34 patients (19.3 %) and 100-150 mghOOml in 38 (21.59 %).

Glibenclamide was used in 108 (60.22 %) patients.

Insulin was used for 70 (39.77 %) patients as follows: conventional two dally injections in 38 (16.72 %) patients, multiple daily insulin injections (intensive treatment) in 18 (10.22 %) patients (single daily injection in 8 (4.5 %) patients) and insulin plus glibenclamide in 6(3, 4 %) patients.

The total daily insulin given on discharge varied between 10 to 80 I.U with a mean of 34.70 hj.

Conclusions, the rate of adequate control of the BG was low.

This is because of the use of inadequate strategies, Glibenclamide was the most commonly used agent.

The use of other novel oral agents in single or in combinations is needed before shifting to insulin, these Include metformin HCL, acarbose, nigital, repaglinide, troglitazone, roslglitazone and others.

Higher doses of insulin preferably as multiple daily injections of soluble insulin given subcutaneously before meals with bed time longer acting insulin is suggested, with frequent daily BG self monitoring as a better alternative to the conventional protocol and with seasonal HBA 1o ratio estimations.

Better Insulin or may be insulin analogues use should be quickly started.