Epidemiology
Inpatient hyperglycaemia is relatively common and is expected to become more prevalent with rising rates of obesity and diabetes in the general population. In 2020, more than 7.86 million adult hospital discharges in the US included a diagnosis of diabetes, either as the primary reason for admission or as a secondary (co-existing) condition.[9] Data from the US indicate that the prevalence of diabetes among hospitalised adults rose by an average of 2.5% per year, increasing from 17.1% in 2000 to 27.3% in 2018.[10] In the UK, the National Diabetes Inpatient Audit similarly reported an increase in diabetes prevalence among inpatients from 15% in 2010 to nearly 20% by 2019.[11] Patients hospitalised with a diagnosis of diabetes tend to have longer hospital stays than those without diabetes who are admitted for the same condition.[12]
In one study, hyperglycaemia was present in 38% of patients admitted to hospital (26% with a known history of diabetes; 12% with no history of diabetes before admission).[5] Prevalence is particularly high among older adults; more than 70% of critically unwell and cardiac surgery patients aged >65 years, and about one-third of general medicine and surgery patients in this age group, experience hyperglycaemia, reflecting both the higher baseline prevalence of diabetes and an increased susceptibility to stress hyperglycaemia with age.[13]
Hypoglycaemia is also a common complication among hospitalised patients, particularly those with diabetes and/or those receiving insulin therapy. In a study of 107,312 hospital admissions, hypoglycaemia occurred in 21,561 patients (20%), with 7539 episodes (7%) classified as severe.[14] Hypoglycaemia can also occur in critically unwell patients without diabetes. The prevalence and incidence of inpatient hypoglycaemia vary depending on the patient population, inpatient setting, and glycaemic threshold used in each study. Rates are higher among more severely unwell patients or those receiving intensive anti-hyperglycaemic regimens, with reports of hypoglycaemia occurring in up to 45% of patients undergoing intensive insulin therapy.[15]
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