Original Article Hyperglycemia management in patients admitted to internal medicine in Spain: A point-prevalence survey examining adequacy of glycemic control and guideline adherence Javier Ena a, ⁎ ,1 , Ricardo Gómez-Huelgas b,1 , Marta Romero-Sánchez c , Antonio Zapatero Gaviria c , Ana Calzada-Valle d , Jose Manuel Varela-Aguilar d , Maria de la Luz Calero-Bernal d , Rosa Garcia-Contreras d , Miguel Angel Berdún-Chéliz e , Borja Gracia-Tello f , Inmaculada Mejias-Real g , Concepción González-Becerra h , on behalf of the Diabetes and Obesity Working Group of the Spanish Society of Internal Medicine a Department of Internal Medicine, Hospital Marina Baixa, Villajoyosa, Alicante, Spain b Department of Internal Medicine, Hospital Regional Universitario de Malaga, Málaga, Spain c Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain d Department of Internal Medicine, Hospital Universitario Virgen del Rocio, Sevilla, Spain e Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain f Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain g Department of Internal Medicine, Hospital Infanta Margarita, Madrid, Spain h Department of Internal Medicine, Hospital San Juan de Dios del Aljarafe, Sevilla, Spain abstract article info Article history: Received 18 January 2015 Received in revised form 21 April 2015 Accepted 22 April 2015 Available online xxxx Keywords: Point-prevalence Diabetes mellitus Hypoglycemic agents Insulin Hospitalization Guideline Aims: Despite the increasing prevalence of hospitalized diabetic patients, there are few studies that evaluate the glycemic control and the rate of adherence to clinical practice guidelines for glucose monitoring and management in the hospital setting. Methods: : Crossover study using one-day surveys of all inpatients admitted to internal medicine wards from volun- tary participating hospitals across Spain. Retrospective review of medical records was used to identify patients with hyperglycemia, causes for hospitalization, patients' demographic characteristics, appropriateness of glycemic monitoring and treatment during hospitalization. Results: Among 5439 hospitalized patients studied there were 1000 (18.4%) with hyperglycemia in 111 participating hospitals. Patients mean age was 76.0 ± 8.5 years (51.6% male). On admission, 91% had known diabetes (disease duration of 10.9 ± 8.5 years), 5% had unknown diabetes and 4% had stress hyperglycemia. The comorbidity index (Charslon score) was 4 (interquartile range: 2 to 6) and 31% showed a high level of disability (Rankin scale). Main infringement in the process of care included lack of a recent HbA1c value (43.7%), use of sliding scale insulin therapy (20.7%), use of oral antidiabetic agents (8.9%), and less than three bedside point-of-care (POC) blood glucose test per day (17%). Glycemic target pre-meal and bedtime were achieved in 47% to 79.5% of POC. The rates of hypoglycemia (b 70 mg/dL and b 50 mg/dL) were 10.3% and 2.4%, respectively. Conclusions: Our results suggest that there is an important gap between the clinical guidelines and both the manage- ment and the grade of glycemic control of diabetic inpatients. © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. 1. Introduction Diabetes is one of the fastest growing pandemics in human history. It has been estimated that 14% of the Spanish adult population has diabetes, and this prevalence may double in the coming decades [1]. In parallel, the percentage of patients with diabetes requiring hospitalization has dou- bled in recent years. Approximately one in four patients admitted to the hospital has a known diagnosis of diabetes [2,3] and about 30% of patients with diabetes require two or more hospitalizations in any given year [3]. The prevalence of diabetes is higher in elderly patients and residents of long-term-care facilities, in whom diabetes is reported in up to one third of adults aged 65–75 yr and in 40% of those older than 80 yr [4,5]. Patients with diabetes are more likely to require hospitalization than subjects without diabetes, mostly due to cardiovascular diseases, but European Journal of Internal Medicine xxx (2015) xxx–xxx ⁎ Corresponding author at: Coordinador Grupo de Diabetes y Obesidad de la SEMI, Department of Internal Medicine, Hospital Marina Baixa, Av Alcalde Jaime Botella Mayor 7, Villajoyosa, 03570 Alicante, Spain. E-mail address: ena_jav@gva.es (J. Ena). 1 Both authors contributed equally to the manuscript. EJINME-02920; No of Pages 7 http://dx.doi.org/10.1016/j.ejim.2015.04.020 0953-6205/© 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect European Journal of Internal Medicine journal homepage: www.elsevier.com/locate/ejim Please cite this article as: Ena J, et al, Hyperglycemia management in patients admitted to internal medicine in Spain: A point-prevalence survey examining adequacy of glycemic..., Eur J Intern Med (2015), http://dx.doi.org/10.1016/j.ejim.2015.04.020