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Elevated blood ketone levels (ketosis) in inpatients with diabetes can herald diabetic ketoacidosis (DKA). However, ketosis can also occur in individuals without diabetes in certain settings. It is unclear what proportion of inpatients with ketosis are in DKA and which patients are at the highest risk of DKA. This study determined that many ketone tests are performed in individuals at low risk of DKA, and a β‐hydroxybutyrate <1.0 mmol/L had a low incidence of DKA and less need for escalation in their management. [ABSTRACT FROM AUTHOR]

Regional centres have smaller workforces in acute diabetes care compared to their metropolitan counterparts. A cross‐sectional audit performed at Albury Hospital identified a high prevalence (34%) of diabetes for inpatients compared with metropolitan centres. The high prevalence highlights the need for all healthcare services to consider appropriate resources for the management of diabetes in people admitted to hospital. [ABSTRACT FROM AUTHOR]

Background and Aims: IDegAsp (Ryzodeg 70/30), a unique premixed formulation of long‐acting insulin degludec and rapid‐acting insulin aspart, is increasing in use. Management of IDegAsp during hospitalisation is challenging because of degludec's ultra‐long duration of action. We investigated inpatient glycaemia in patients treated with IDegAsp compared to biphasic insulin aspart (BIAsp30; Novomix30). Methods: We performed a retrospective observational study at two hospitals assessing inpatients with type 2 diabetes treated with IDegAsp or BIAsp30 prior to and during hospital admission. Standard inpatient glycaemic outcomes were analysed based on capillary blood glucose (BG) measurements. Results: We assessed 88 individuals treated with IDegAsp and 88 HbA1c‐matched individuals treated with BIAsp30. Patient characteristics, including insulin dose at admission, were well matched, but the IDegAsp group had less frequent twice‐daily insulin dosing than the BIAsp30 group (49% vs 87%, P < 0.001). Patient‐days with BG <4 mmol/L were not different (10.6% vs 9.9%, P = 0.7); however, the IDegAsp group had a higher patient‐day mean BG (10.4 (SD 3.4) vs 10.0 (3.4) mmol/L, P < 0.001), and more patient‐days with mean BG >10 mmol/L (48% vs 38%, P < 0.001) compared to the BIAsp30 group. Glucose was higher in the IDegAsp group in the evening (4 PM to midnight) (11.6 (SD 4.0) vs 10.9 (4.6) mmol/L, P = 0.004), but not different at other times during the day. Conclusions: Inpatients treated with IDegAsp compared to BIAsp30 had similar hypoglycaemia incidence, but higher hyperglycaemia incidence, potentially related to less frequent twice‐daily dosing. With the increasing use of IDegAsp in the community, development of hospital management guidelines for this insulin formulation is needed. [ABSTRACT FROM AUTHOR]

Background and Aims: Given treatment‐related hypoglycaemia in hospitals can lead to adverse outcomes, the Australian Commission on Safety and Quality in Health Care has included hypoglycaemia as a reportable hospital‐acquired complication (HAC) with financial disincentives. However, the designation of a hypoglycaemia HAC relies on clinical coding without a defined glucose threshold or clinical context. We assessed the biochemical validity and clinical relevance of a hypoglycaemia HAC. Methods: We performed a retrospective review on patients discharged from the Northern Health hospitals between March and August 2021 who were designated as experiencing a hypoglycaemia HAC. We assessed cases for biochemical validity (glucose <4.0 mmol), clinical context and whether they were treatment‐related (treatment with insulin or sulphonylurea). We then compared this cohort with a hospital‐wide glucometric survey based on a point‐prevalence study to determine the proportion of individuals with hypoglycaemic events that were designated as hypoglycaemia HAC. Results: Two hundred fifty‐six admissions were coded as hypoglycaemia HAC. Eleven (4%) did not have a biochemically valid episode. Of the valid cases, 34 (14%) were not treated with any glucose‐lowering medication and 11 (4%) were treated with noninsulin, nonsulphonylurea glucose‐lowering medication. Two hundred admissions (78%) were considered treatment‐related HAC. Of 139 individuals with diabetes identified in the hospital‐wide point‐prevalence study, 25 (18%) had biochemical evidence for hypoglycaemia: 22 were treatment‐related, of which 68% were not coded as HAC. Conclusion: Given safety and cost implications, the designation of hypoglycaemia HAC requires a standardised definition incorporating a biochemical threshold and clinical context. We propose a clinically relevant definition of hypoglycaemia HAC to promote safe diabetes care. [ABSTRACT FROM AUTHOR]

A recent pilot study published in Diabetes Care by Kaminski et al. examined glycemia in patients with end-stage kidney disease (ESKD) and "burnt-out diabetes" using a Dexcom G6 continuous glucose monitor (CGM). The study found that traditional measures of glycemic control may not accurately detect hyperglycemia in patients with burnt-out diabetes, but CGM use can. The accuracy of CGM in patients requiring hemodialysis is still being studied, but preliminary data suggests that Dexcom G6 may be accurate enough for use in these patients. Further research is needed to establish the reliability of CGM glucose results in dialysis-requiring patients. [Extracted from the article]

Background and Aims: A relationship between diabetes, glucose and COVID‐19 outcomes has been reported in international cohorts. This study aimed to assess the relationship between diabetes, hyperglycaemia and patient outcomes in those hospitalised with COVID‐19 during the first year of the Victorian pandemic prior to novel variants and vaccinations. Design, setting: Retrospective cohort study from March to November 2020 across five public health services in Melbourne, Australia. Participants: All consecutive adult patients admitted to acute wards of participating institutions during the study period with a diagnosis of COVID‐19, comprising a large proportion of patients from residential care facilities and following dexamethasone becoming standard‐of‐care. Admissions in patients without known diabetes and without inpatient glucose testing were excluded. Results: The DINGO COVID‐19 cohort comprised 840 admissions. In 438 admissions (52%), there was no known diabetes or in‐hospital hyperglycaemia, in 298 (35%) patients had known diabetes, and in 104 (12%) patients had hyperglycaemia without known diabetes. ICU admission was more common in those with diabetes (20%) and hyperglycaemia without diabetes (49%) than those with neither (11%, P < 0.001 for all comparisons). Mortality was higher in those with diabetes (24%) than those without diabetes or hyperglycaemia (16%, P = 0.02) but no difference between those with in‐hospital hyperglycaemia and either of the other groups. On multivariable analysis, hyperglycaemia was associated with increased ICU admission (adjusted odds ratio (aOR) 6.7, 95% confidence interval (95% CI) 4.0–12, P < 0.001) and longer length of stay (aOR 173, 95% CI 11–2793, P < 0.001), while diabetes was associated with reduced ICU admission (aOR 0.55, 95% CI 0.33–0.94, P = 0.03). Neither diabetes nor hyperglycaemia was independently associated with in‐hospital mortality. Conclusions: During the first year of the COVID‐19 pandemic, in‐hospital hyperglycaemia and known diabetes were not associated with in‐hospital mortality, contrasting with published international experiences. This likely mainly relates to hyperglycaemia indicating receipt of mortality‐reducing dexamethasone therapy. These differences in published experiences underscore the importance of understanding population and clinical treatment factors affecting glycaemia and COVID‐19 morbidity within both local and global contexts. [ABSTRACT FROM AUTHOR]

The article discusses the Randomized Study of a Proactive Inpatient Diabetes Service-extension observational study to assess glycemic and clinical outcomes after cessation of early intervention care. Highlights include the use of point-of-care capillary blood glucose measurements for each patient to analyze glucometric outcomes, comparison between hyperglycemia and hospital-acquired infection incidence, and reductions in hyperglycemic extremes associated with improved clinical outcomes.

Low-voltage-activated, or T-type, calcium (Ca2+) channels are believed to play an essential role in the generation of absence seizures in the idiopathic generalized epilepsies (IGEs). We describe a homozygous, missense, single nucleotide (G to C) mutation in the Cav3.2 T-type Ca2+ channel gene (Cacna1h) in the genetic absence epilepsy rats from Strasbourg (GAERS) model of IGE. The GAERS Cav3.2 mutation ( gcm) produces an arginine to proline (R1584P) substitution in exon 24 of Cacna1h, encoding a portion of the III-IV linker region in Cav3.2. gcm segregates codominantly with the number of seizures and time in seizure activity in progeny of an F1 intercross. We have further identified two major thalamic Cacna1h splice variants, either with or without exon 25. gcm introduced into the splice variants acts "epistatically," requiring the presence of exon 25 to produce significantly faster recovery from channel inactivation and greater charge transference during high-frequency bursts. This gain-of-function mutation, the first reported in the GAERS polygenic animal model, has a novel mechanism of action, being dependent on exonic splicing for its functional consequences to be expressed. [ABSTRACT FROM AUTHOR]

Background: While glucometric benchmarking has been used to compare glucose management between institutions, the value of longitudinal intra-institution benchmarking to assess quality improvement changes is not established., Methods: A prospective six-month observational study (October 2019-March 2020 inclusive) of inpatients with diabetes or newly detected hyperglycemia admitted to eight medical and surgical wards at the Royal Melbourne Hospital. Networked blood glucose (BG) meters were used to collect capillary BG levels. Outcomes were measures of glycemic control assessed by mean and threshold glucometric measures and comparison with published glucometric benchmarks. Intra-institution comparison was over the 2016-2020 period., Results: In all, 620 admissions (588 unique individuals) met the inclusion criteria, contributing 15 164 BG results over 4023 admission-days. Compared with the 2016 cohort from the same institution, there was increased BG testing (3.8 [SD = 2.2) vs 3.3 [SD = 1.7] BG measurements per patient-day, P < .001), lower mean patient-day mean glucose (PDMG; 8.9 mmol/L [SD = 3.2] vs 9.5 mmol/L [SD = 3.3], P < .001), and reduced mean and threshold measures of hyperglycemia ( P < .001 for all). Comparison with institutions across the United States revealed lower incidence of mean PDMG >13.9 or >16.7 mmol/L, and reduced hypoglycemia (<3.9, <2.8, and <2.2 mmol/L), when compared with published benchmarks from an earlier period (2009-2014)., Conclusions: Comprehensive digital-based glucometric benchmarking confirmed institutional quality improvement changes were followed by reduced hyperglycemia and hypoglycemia in a five-year comparison. Longitudinal glucometric benchmarking enables evaluation and validation of changes to institutional diabetes care management practices., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Context: Hyperglycemia in hospital inpatients without pre-existing diabetes is associated with increased mortality. However, the independent contribution of hyperglycemia to healthcare-associated infection (HAI), acute kidney injury (AKI), and stroke is unclear., Objective: To investigate the relationship between hyperglycemia and adverse clinical outcomes in hospital for patients with and without diabetes., Design: Diabetes IN-hospital: Glucose and Outcomes (DINGO) was a 26-week (October 2019 - March 2020) prospective cohort study. Clinical and glucose data were collected up to the 14th day of admission. Primary stratification was by hyperglycemia, defined as ≥2 random capillary blood glucose (BG) measurements ≥11.1 mmol/L (≥200 mg/dL). Propensity weighting for nine clinical characteristics, was performed to allow interrogation of causality. To maintain the positivity assumption, patients with HbA1c > 12.0% were excluded and pre-hospital treatment not adjusted for., Setting: The Royal Melbourne Hospital, a quaternary referral hospital in Melbourne, Australia., Patients: Admissions with at least two capillary glucose values and length of stay >24 hours were eligible, with half randomly sampled., Outcome Measures: HAI, AKI, stroke, and mortality., Results: Of 2,558 included admissions, 1,147 (45%) experienced hyperglycemia in hospital. Following propensity-weighting and adjustment, hyperglycemia in hospital was found to, independently of nine covariables, contribute an increased risk of in-hospital HAI (130 [11.3%] vs.100 [7.1%], adjusted odds ratio [aOR] 1.03, 95% confidence interval [95%CI] 1.01-1.05, p = 0.003), AKI (120 [10.5%] vs. 59 [4.2%], aOR 1.07, 95%CI 1.05-1.09, p < 0.001), and stroke (10 [0.9%] vs. 1 [0.1%], aOR 1.05, 95%CI 1.04-1.06, p < 0.001)., Conclusions: In hospital inpatients (HbA1c ≤ 12.0%), irrespective of diabetes status and pre-hospital glycaemia, hyperglycemia increases the risk of in-hospital HAI, AKI, and stroke compared with those not experiencing hyperglycemia., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)