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This article provides an up-to-date guide to the types of assistive technology designed for patients with diabetes.

Background/AimsNetworked glucose blood monitoring has been demonstrated as a useful process of care for improving glycaemia and clinical outcomes in hospital inpatients. However, these benefits are partly reliant on the accurate entry of patients' medical record numbers by healthcare staff. This study assessed the accuracy of such data entry, comparing the periods before and after the onset of the COVID-19 pandemic.MethodsThis retrospective observational study analysed glucose meter medical record number entries at a large hospital in Victoria, Australia. The study period spanned from September 2019, when the networked blood glucose monitoring system was introduced, to July 2020. The proportion of inaccurate entries were presented as a percentage of the total number of entries and comparisons were made between the pre-COVID-19 and post-COVID-19 onset periods. Data were analysed using an interrupted time series methodology and presented using a Quasipoisson distribution.ResultsA gradual decrease in the percentage of accurate medical record number entries was observed following the introduction of the networked blood glucose monitoring system. This decline in accuracy decreased further following the onset of COVID-19, despite the hospital serving a relatively low number of patients with the virus.ConclusionsThe ongoing decrease in accuracy of data entry into the networked blood glucose monitoring system is thought to be a result of insufficient training and time constraints, which were exacerbated by the COVID-19 pandemic because of protocol changes and furloughed staff. It is recommended that accurate use of the networked blood glucose monitoring system is allocated more regular training in hospital wards.

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.Retrospective cohort study from March to November 2020 across five public health services in Melbourne, Australia.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.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.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.

Objective: To investigate the relationship between hyperglycemia and adverse in-hospital outcomes in patients with and without known diabetes Research Design and Methods: The Diabetes IN-hospital: Glucose and Outcomes (DINGO) prospective cohort study was conducted over 26 weeks between Oct-20 and Mar-2020 at The Royal Melbourne Hospital. Admissions with ≥2 capillary glucose values and length of stay >24 hours were eligible. Stratification was by in-hospital hyperglycemia (IHH) , defined as ≥2 capillary glucose values of ≥11.1 mmol/L [≥200 mg/dL]. Results: We included 2,6admissions, of which 1,189 (46%) experienced in-hospital hyperglycemia. Following adjustment (covariates) , IHH was independently associated with in-hospital healthcare-associated infection (HAI) , acute kidney injury (AKI) , stroke, and mortality (see figure for incidence rate ratios [IRR]) . For each outcome the association was independent of diabetes status, except for mortality where the association was stronger in those without known diabetes. Patient-day mean glucose was elevated in those with HAI and AKI, on both whole-of-admission and prior-to-event calculations. Conclusions: In-hospital hyperglycemia is independently associated with in-hospital HAI and AKI in patients with and without known diabetes. Disclosure R.Barmanray: None. M.Kyi: None. L.J.Worth: None. P.G.Colman: None. T.N.Fazio: None. G.Rayman: None. S.Fourlanos: Advisory Panel; Pfizer Inc., Viatris Inc., Speaker's Bureau; AstraZeneca, Novo Nordisk. Funding Rowe Family Foundation Perpetual GrantAustralian Government Research Training Program Scholarship

Disorders of tonicity, hyponatraemia and hypernatraemia, are common in neurosurgical patients. Tonicity is sensed by the circumventricular organs while the volume state is sensed by the kidney and peripheral baroreceptors; these two signals are integrated in the hypothalamus. Volume is maintained through the renin-angiotensin-aldosterone axis, while tonicity is defended by arginine vasopressin (antidiuretic hormone) and the thirst response. Edelman found that plasma sodium is dependent on the exchangeable sodium, potassium and free-water in the body. Thus, changes in tonicity must be due to disproportionate flux of these species in and out of the body. Sodium concentration may be measured by flame photometry and indirect, or direct, ion-sensitive electrodes. Only the latter method is not affected by changes in plasma composition. Classification of hyponatraemia by the volume state is imprecise. We compare the tonicity of the urine, given by the sodium potassium sum, to that of the plasma to determine the renal response to the dysnatraemia. We may then assess the activity of the renin-angiotensin-aldosterone axis using urinary sodium and fractional excretion of sodium, urate or urea. Together, with clinical context, these help us determine the aetiology of the dysnatraemia. Symptomatic individuals and those with intracranial catastrophes require prompt treatment and vigilant monitoring. Otherwise, in the absence of hypovolaemia, free-water restriction and correction of any reversible causes should be the mainstay of treatment for hyponatraemia. Hypernatraemia should be corrected with free-water, and concurrent disorders of volume should be addressed. Monitoring for overcorrection of hyponatraemia is necessary to avoid osmotic demyelination.

Perioperative diabetes management has become increasingly complex; management is often inconsistent resulting in dysglycaemia and associated morbidity.To evaluate a structured pre-admission perioperative diabetes management plan (PDMP) for safe and appropriate recommendation, prescription and administration of diabetes medications in the perioperative period for people with diabetes undergoing elective, non-cardiac surgery.A multidisciplinary team developed the intervention, a structured PDMP (including diabetes medication reconciliation, management guide, individualised plan) to standardise optimal perioperative diabetes management. A single centre prospective pre- and post-intervention pilot study was performed, including all individuals with diabetes medications attending the pre-admissions clinic during two 4-month periods (February to May) in 2016 (control period) and 2017 (intervention period). The primary outcome was appropriate recommendation, prescription and administration of diabetes medications (including insulin), according to the PDMP, in the perioperative period. Secondary outcomes measures were glycaemia. Analysis was by intention to treat.Control and intervention groups included 131 and 133 participants, respectively; they were well matched in clinical characteristics. The PDMP was completed correctly in 100 (75%) individuals in the intervention group. The appropriate use of diabetes medications increased from 30% in the control group to 71% in the intervention group (p 0.001). Following the PDMP implementations, glycaemia improved in the overall perioperative period (8.7 ± 2.9 vs. 9.8 ± 3.3 mmol/L, p = 0.005) and at all time points (from admission and over entire hospital stay).A structured pre-admission perioperative diabetes management plan for elective surgery improved safe and appropriate diabetes medication use and glycaemia in the perioperative period.

Background/Aims Diabetes mellitus is increasingly prevalent among hospital inpatients. Management requires regular blood glucose monitoring by nurses, yet research into nurse perceptions of glucose management importance is lacking. Methods A 5-point Likert-scale survey was administered to 718 nurses at an Australian tertiary centre. Nurses were predominantly from acute medical wards (57%) and in the first decade of their career (66%). Results The six tested aspects of glucose monitoring were perceived as important by the majority, but the importance of timely management of abnormal glucose was rated lower by clinical nurse educators (4.33 vs 4.70, P=0.019) and by nurses with 5 or more years of experience compared with first-year nurses. Both predictors remained significant following multivariable adjustment (educator status odds ratio 0.51, P=0.043, years of nursing experience odds ratio 0.84, P=0.018). Conclusions These findings imply that concurrent nurse (re-)education in glucose management should be considered in the design and implementation of future glucose management programmes.

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 (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.

A point-prevalence study of inpatient diabetes management at a Melbourne metropolitan hospital detected diabetes-related medication errors in 20% (21/105) of inpatients, in addition to signicant therapeutic inertia in response to adverse glycaemia. Following an initial hypoglycaemic episode, most individuals did not receive treatment adjustment, and 72% experienced recurrent hypoglycaemia. Acoordinated proactive approach to inpatient diabetes care is urgently needed.

OBJECTIVE: To assess glucometric outcomes and to estimate the incidence of hypo- and hyperglycaemia among non-critical care inpatients in a major Australian hospital. DESIGN, SETTING AND PARTICIPANTS: A prospective 10-week observational study (7 March - 22 May 2016) of consecutive inpatients with diabetes or newly detected hyperglycaemia admitted to eight medical and surgical wards at the Royal Melbourne Hospital. Point-of-care blood glucose (BG) data were collected with networked glucose meters. MAIN OUTCOME MEASURES: Glycaemic control, as assessed with three glucometric models (by population, by patient, by patient-day); incidence of adverse glycaemic days (AGDs; patient-days with BG levels below 4 mmol/L or above 15 mmol/L). RESULTS: During the study period, there were 465 consecutive admissions of 441 patients with diabetes or newly detected hyperglycaemia, and 9817 BG measurements over 2953 patient-days. The mean patient-day BG level was 9.5 mmol/L (SD, 3.3 mmol/L). The incidence of hyperglycaemia was higher than for a United States hospital benchmark (patient-days with mean BG level above 10 mmol/L, 37% v 32), and that of hypoglycaemia lower (proportion of patient-days with mean BG level below 3.9 mmol/L, 4.1% v 6.1%). There were 260 (95% CI, 245-277) AGDs per 1000 patient-days; the incidence was higher in medical than surgical ward patients (290 [CI, 270-310] v 206 [CI, 181-230] per 1000 patient-days). 604 AGDs (79%) were linked with 116 patients (25%). Episodes of hyperglycaemia (BG above 15 mmol/L) were more frequent before lunch, dinner, and bedtime; 94 of 187 episodes of hypoglycaemia (BG below 4 mmol/L) occurred between 11 pm and 8 am. DISCUSSION: Glucometric analysis supported by networked glucose meter technology provides detailed inpatient data that could enable local benchmarking for promoting safe diabetes care in Australian hospitals.

CONTEXT: Diabetic ketoacidosis (DKA) has been associated with the use of sodium glucose cotransporter 2 inhibitors (SGLT2is). OBJECTIVE: To determine the incidence, characteristics, and outcomes of DKA in SGLT2i users vs nonusers with type 2 diabetes. DESIGN: Retrospective, multicenter, controlled cohort study. SETTING: All public hospitals in Melbourne and Geelong (combined population of 5 million), Australia, from 1 September 2015 to 31 October 2017. PATIENTS: Consecutive cases of DKA that developed in the community, or during the course of hospital admission, in patients with type 2 diabetes. MAIN OUTCOME MEASURES: In SGLT2i users vs nonusers: (i) OR of DKA developing during hospital admission, and (ii) incidence of DKA. RESULTS: There were 162 cases of DKA (37 SGLT2i users and 125 non-SGLT2i users) with a physician-adjudicated diagnosis of type 2 diabetes. Of these, DKA developed during the course of inpatient admission in 14 (38%) SGLT2i users vs 2 (2%) non-SGLT2i users (OR, 37.4; 95% CI, 8.0 to 175.9; P < 0.0001). The incidence of DKA was 1.02 per 1000 (95% CI, 0.74 to 1.41 per 1000) in SGLT2i users vs 0.69 per 1000 (95% CI, 0.58 to 0.82 per 1000) in non-SGLT2i users (OR, 1.48; 95% CI, 1.02 to 2.15; P = 0.037). Fifteen SGLT2i users (41%) had peak blood glucose

Although diabetes is a recognized risk factor for postoperative infections, the seminal Portland Diabetic Project studies in cardiac surgery demonstrated intravenous insulin infusions following open-cardiac surgery achieved near normal glycaemia and decreased deep sternal wound infection to similar rates to those without diabetes.We sought to examine a contemporary cohort of patients undergoing coronary artery bypass graft surgery (CABGS) to evaluate the relationship between diabetes, hyperglycaemia and risk of surgical site infection (SSI) in current-era models of care.Consecutive patients who underwent CABGS between 2016 and 2018 were identified through a state-wide data repository for healthcare-associated infections. Clinical characteristics and records of postoperative SSIs were obtained from individual chart review. Type 2 diabetes (T2D), perioperative glycaemia and other clinical characteristics were analysed in relation to the development of SSI.Of the 953 patients evaluated, 11% developed SSIs a median eight days post CABGS, with few cases of deep SSIs (1%). T2D was evident in 41% and more prevalent in those who developed SSIs (51%). On multivariate analysis T2D was not significantly associated with development of SSI (odds ratio (OR) 1.35; P=0.174) but body mass index (BMI) remained a significant risk factor (OR 1.07, P0.001). In patients with T2D, perioperative glycaemia was not significantly associated with SSI.In a specialist cardiac surgery centre using perioperative intravenous insulin infusions and antibiotic prophylaxis, deep SSIs were uncommon; however, approximately one in 10 patients developed superficial SSIs. T2D was not independently associated with SSI yet BMI was independently associated with SSI post CABGS.

Background: We previously reported an early intervention model of diabetes care, whereby an inpatient diabetes team performed glycemic surveillance and provided proactive management within 24 hours of admission. In the RAPIDS cluster randomized study, early intervention decreased hyperglycemia and hospital-acquired infection (HAI) compared to usual care [Diabetes Care. 2019;42(5):832-40]. We investigated if improvements in ward glucose control and patient outcomes were sustained following the completion of proactive care intervention. Methods: We performed a 3-month extension observational study on eight medical and surgical wards immediately following the completion of the RAPIDS study, recruiting consecutive inpatients with pre-existing diabetes or new hyperglycemia. Glycemic and clinical outcomes during the three time periods: baseline (usual care), active (proactive care), and extension (usual care) were compared. Results: We analyzed 1518 inpatients (mean age 71y, 87% type 2 diabetes, 25% insulin-treated) and observed 8610 patient-days. In the intervention wards, during baseline, active and extension periods, patient-day mean glucose were: mean 9.4 (SD 3.3), 9.0 (2.7), and 9.4 (3.1) mmol/L (p15 mmol/L were 7.3%, 3.3%, and 5.7% (p Conclusion: Following withdrawal of proactive care with early intervention, hyperglycemia and HAI rates increased to baseline levels. Ongoing intervention with specialist diabetes care teams may be required to achieve sustained glycemic and clinical improvements in hospital. Disclosure M. Kyi: None. J. Wang: None. P.R. Wraight: None. P.G. Colman: None. S. Fourlanos: Advisory Panel; Self; Medtronic, Mylan, Sanofi. Speaker’s Bureau; Self; AstraZeneca, Novo Nordisk Inc. Funding Australian Diabetes Society; Sanofi; National Health and Medical Research Council of Australia (APP1093152); Royal Melbourne Hospital (GIA-030-2019, GIA-027-2016)

To investigate the effect of a novel glucose alert system, comprising the Melbourne Glucose Alert Pathway and glucose-alert-capable networked blood glucose meters, on nursing and hospital medical officer responses to adverse glycaemia.A prospective, pre- and post-observational study was undertaken in non-critical care wards of a tertiary hospital over 4 months (n=148 or 660 patient-days). The intervention consisted of two components designed to promote a consistent staff response to blood glucose measurements: (1) a clinical escalation pathway, the Melbourne Glucose Alert Pathway, and (2) networked blood glucose meters, which provide a visual alert for out-of-range blood glucose measurement. All consecutive inpatients with diabetes were assessed for diabetes management and capillary blood glucose. The primary outcome was documented nursing and medical staff action in response to episodes of adverse glycaemia (blood glucose15 mmol/l or4 mmol/l). Secondary outcomes consisted of glycaemic measures.In response to episodes of adverse glycaemia, nursing action increased (proportion with nursing action: 45% to 73%; P0.001), and medical action increased (proportion with medical action: 49% to 67%; P=0.011) with the glucose alert system in place. Patient-days with hyperglycaemia (any blood glucose value15 mmol/l: 24% vs 16%; P=0.012) and patient-days with mean blood glucose15 mmol/l (7.4% vs 2.6%; P=0.005) decreased. There was no difference in hypoglycaemia incidence.Use of a novel glucose alert system improved health professional responses to adverse glycaemia and decreased hyperglycaemia in the hospital setting.

Hyperglycemia is associated with hospital-acquired infection (HAI) and mortality, and treating hyperglycemia can improve outcomes in noncritical care (1,2). We previously reported the cluster Randomized Study of a Proactive Inpatient Diabetes Service (RAPIDS), where an early intervention model of diabetes care was investigated in medical and surgical inpatients (3). A proactive specialist diabetes team performed electronic glycemic surveillance and provided early bedside management for all inpatients with diabetes or hyperglycemia and demonstrated a 55% reduction in severe hyperglycemia (patient-days with mean blood glucose [BG] >270 mg/dL) and a 62% reduction in HAI. At the conclusion of RAPIDS, the proactive model of care was ceased due to lack of ongoing funding for this health care initiative. We performed this RAPIDS-extension observational study to evaluate glycemic and clinical outcomes after cessation of early intervention care, hypothesizing that hyperglycemia and HAI incidence would deteriorate back to baseline levels. RAPIDS included patients of eight medical and surgical wards at the tertiary Royal Melbourne Hospital, who were randomized to control or intervention arms. RAPIDS comprised a 10-week baseline period, where patients in all wards received usual care (diabetes management mostly performed by treating teams), followed by a 12-week active period, when patients in the intervention wards received proactive care (by an …

Adverse glycaemia in hospital is associated with worse clinical outcomes. Given the high prevalence of diabetes in the cardiology wards, we introduced an early intervention model of diabetes care in high-risk inpatients aiming to decrease adverse glycaemia. A prospective pre- and post-intervention study was conducted in a tertiary referral hospital cardiology ward. It consisted of an initial 6-month baseline phase of standard care (a ‘reactive’ referral-based diabetes consultation service), followed by an 9-month intervention phase, comprising a ‘proactive’ multidisciplinary inpatient diabetes team (IDT) assisted by networked blood glucose (BG) meter technology. The proactive IDT performed electronic surveillance of capillary BG measurements and provided an early consultation service (within 24 hours of admission), without waiting for referral from the parent team. Consecutive inpatients admitted to the cardiology ward (length of stay >48 hours) at high risk of adverse glycaemia (insulin treatment prior to hospital; or BG 15 or two BG >10 mmol/L in the first 48 hours) were recruited. BG data from day 2 until discharge, along with demographic and clinical features, was collected. The primary outcome was the incidence of adverse glycaemic days (AGD) (rate per 1000 patient-days with any capillary BG measure 15 mmol/L). Overall, we observed 332 patients (1320patient-days and 4887 BG measurements). Compared to usual care, the incidence of AGD decreased from 405 to 320 per 1000 patient-days (21% decrease, p=0.002) which remained significant after MVA adjustment. During the intervention phase, there was decreased mean (±SD) patient-day BG (10.8 ±3.3 vs. 10.1 ±2.8, p15 mmol/L) (10.4% vs. 6.1%, p=0.044) with no significant difference in patient-days with hypoglycaemia. Analysis of clinical outcomes is pending. An early intervention model of diabetes care decreased adverse glycaemia in cardiology in patients with diabetes. Disclosure S. Fourlanos: None. N.D. Mingos: None. L.M. Rowan: None. R. Barmanray: None. M. Kyi: None.

OBJECTIVE To investigate if early electronic identification and bedside management of inpatients with diabetes improves glycemic control in noncritical care. RESEARCH DESIGN AND METHODS We investigated a proactive or early intervention model of care (whereby an inpatient diabetes team electronically identified individuals with diabetes and aimed to provide bedside management within 24 h of admission) compared with usual care (a referral-based consultation service). We conducted a cluster randomized trial on eight wards, consisting of a 10-week baseline period (all clusters received usual care) followed by a 12-week active period (clusters randomized to early intervention or usual care). Outcomes were adverse glycemic days (AGDs) (patient-days with glucose 15 mmol/L [270 mg/dL]) and adverse patient outcomes. RESULTS We included 1,002 consecutive adult inpatients with diabetes or new hyperglycemia. More patients received specialist diabetes management (92% vs. 15%, P < 0.001) and new insulin treatment (57% vs. 34%, P = 0.001) with early intervention. At the cluster level, incidence of AGDs decreased by 24% from 243 to 186 per 1,000 patient-days in the intervention arm (P < 0.001), with no change in the control arm. At the individual level, adjusted number of AGDs per person decreased from a mean 1.4 (SD 1.6) to 1.0 (0.9) days (−28% change [95% CI −45 to −11], P = 0.001) in the intervention arm but did not change in the control arm (1.8 [2.0] to 1.5 [1.8], −9% change [−25 to 6], P = 0.23). Early intervention reduced overt hyperglycemia (55% decrease in patient-days with mean glucose >15 mmol/L, P < 0.001) and hospital-acquired infections (odds ratio 0.20 [95% CI 0.07–0.58], P = 0.003). CONCLUSIONS Early identification and management of inpatients with diabetes decreased hyperglycemia and hospital-acquired infections.

Objectives Given the high incidence of hyperglycemia and hypoglycemia in hospital and the lack of prediction tools for this problem, we developed a clinical tool to assist early identification of individuals at risk for persistent adverse glycemia (AG) in hospital. Methods We analyzed a cohort of 594 consecutive adult inpatients with type 2 diabetes. We identified clinical factors available early in the admission course that were associated with persistent AG (defined as ≥2 days with capillary glucose 15 mmol/L during admission). A prediction model for persistent AG was constructed using logistic regression and internal validation was performed using a split-sample approach. Results Persistent AG occurred in 153 (26%) of inpatients, and was associated with admission dysglycemia (odds ratio [OR], 3.65), glycated hemoglobin ≥8.1% (OR, 5.08), glucose-lowering treatment regimen containing sulfonylurea (OR, 3.50) or insulin (OR, 4.22), glucocorticoid medication treatment (OR, 2.27), Charlson Comorbidity Index score and the number of observed days. An early-identification prediction tool, based on clinical factors reliably available at admission (admission dysglycemia, glycated hemoglobin, glucose-lowering regimen and glucocorticoid treatment), could accurately predict persistent AG (receiver-operating characteristic area under curve = 0.806), and, at the optimal cutoff, the sensitivity, specificity and positive predictive value were 84%, 66% and 53%, respectively. Conclusions A clinical prediction tool based on clinical risk factors available at admission to hospital identified patients at increased risk for persistent AG and could assist early targeted management by inpatient diabetes teams.

We previously showed that a proactive inpatient diabetes service decreased adverse glycemia (AG) and hospital acquired infections (RAPIDS: ADA2017, 231-OR). To further focus our proactive care on high-risk inpatients, we investigated clinical risk factors associated with AG. We analyzed multiple clinical variables in 643 consecutive inpatients with diabetes or new hyperglycemia (random BG ≥11.1mmol/L). Capillary BG from day 2 of admission until discharge (censored at day 14) were analyzed. AG was defined as BG 15mmol/L on any day and recurrent AG (RAG) was defined as AG on ≥2 days. A split-sample multivariable logistical regression was performed with internal validation. The patient characteristics included 87% type 2 diabetes, 33% insulin-treated and mean HbA1c 7.6%. AG and RAG occurred in 278 (43%), and 176 (27%) patients respectively. Pre-hospital factors (sulphonylurea or insulin treatment, HbA1c, Charlson index) and in-hospital factors (dysglycemia on day 1, length of stay) were independently associated with both AG and RAG (Table). Glucocorticoid treatment was associated with RAG but not AG. A model using these multiple variables accurately identified AG (ROC-AUC 0.88). Age, diabetes type, creatinine and admission unit were not associated with either AG or RAG. This study identified multiple key clinical risk factors associated with adverse glycemia, and may be used to better concentrate efforts for inpatient diabetes care. Disclosure M. Kyi: None. J.E. Reid: None. A. Gorelik: None. S.S. Kumar: None. A. Galligan: None. L.M. Rowan: Speaker's Bureau; Self; AstraZeneca, Sanofi, Novo Nordisk Inc.. A.J. Nankervis: None. K.A. Marley: None. D.M. Russell: None. P.R. Wraight: None. P.G. Colman: None. S. Fourlanos: None.

The perioperative management of diabetes inpatients is complex, often inconsistent and frequently results in suboptimal glycemia. We designed, implemented and evaluated a structured perioperative diabetes management plan (PDMP) on appropriate diabetes medication usage and glycemia in the perioperative period, in elective non-cardiac surgery patients. A multidisciplinary team developed and implemented a novel structured PDMP at our tertiary hospital. This observational study audited perioperative diabetes management over 4 months pre-implementation (non-structured care) and 4 months post-implementation (structured PDMP care). Primary outcome was appropriate use (documented recommendation, prescription and administration) of diabetes medications in the perioperative period. Secondary outcomes included blood glucose (BG) monitoring practice and glycemia. Pre- and post-implementation groups comprised 138 and 141 patients respectively, all of whom attended preadmission clinic and were admitted on the day of the procedure. The two groups were well matched in clinical characteristics. The PDMP was completed correctly in 107 (76%) patients in the post-implementation group. The appropriate use of diabetes medications increased from 30% to 72% between pre- and post-implementation groups (p Disclosure Q. Qi: None. E.J. Pemberton: None. M. Kyi: None. P.G. Colman: None. S. Fourlanos: None.

Background Diabetic foot infections are an important cause of hospitalization, health expenditure and mortality. Bone biopsy is the gold standard for diagnosing diabetic foot osteomyelitis [1] but it is not routinely performed in most centres. Instead, a combination of history, examination, biochemical and radiological findings are used to make the diagnosis. Case Report Here, we report a case mimicking diabetic foot osteomyelitis, where the histology was crucial in acquiring the correct diagnosis. Conclusion The absence of ulceration in cases of presumed diabetic foot osteomyelitis should raise suspicion of potential rare mimics of osteomyelitis and bone biopsy should be considered to further evaluate the underlying etiology prior to any definitive surgical management.

Type 1 diabetes (T1D) is caused by an autoimmune attack on pancreatic beta cells that leads to insulin deficiency. The incidence of T1D in Australia has doubled over the past 20 years. T1D treatment focuses on physiological insulin replacement, aiming for near-normal blood glucose levels. Hypoglycaemia is a significant cause of morbidity and mortality in T1D. Optimal T1D management is complex, and is enhanced by empowering individuals in all aspects of managing diabetes. New technologies, including insulin pumps, continuous glucose monitors and sensor-augmented pumps, can assist people achieve better glycaemic control and reduce the risk of severe hypoglycaemia. Women with T1D can achieve significantly better outcomes during pregnancy and for their infants by planning for their pregnancy and by intensive glycaemic control. Several trials are underway that seek to identify the determinants of autoimmunity and to develop therapies that prevent T1D in at-risk individuals. Pancreatic and islet cell transplants are proven therapies, but are only offered to individuals with diabetes and renal failure (pancreas) or severe hypoglycaemia unawareness (islet cell transplants). Although T1D is still associated with considerable premature mortality, recent findings show that a significant improvement in life expectancy has occurred.

The oscillatory rhythms underlying many physiological and pathological states, including absence seizures, require both the thalamus and cortices for full expression. A co-culture preparation combining cortical and thalamic explants provides a unique model for investigating how such oscillations initiate and spread. Here we investigated the dynamics of synchronized thalamocortical activity by simultaneous measurement of field-potential recordings and rapid imaging of Ca(2+) transients by fluorescence methods. Spontaneous sustained hypersynchronized "seizure-like" oscillations required reciprocal cortico-thalamocortical connections. Isolated cortical explants can independently develop brief discharges, while thalamic explants alone were unable to do so. Rapid imaging of Ca(2+) transients demonstrated deep-layer cortical initiation of oscillatory network activity in both connected and isolated explants. Further, cortical explants derived from a rat model of genetic absence epilepsy showed increased bursting duration consistent with an excitable cortex. We propose that thalamocortical oscillatory network activity initiates in deep layers of the cortex with reciprocal thalamic interconnections enabling sustained hyper-synchronization.

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 ofCacna1h, encoding a portion of the III–IV linker region in Cav3.2.gcmsegregates codominantly with the number of seizures and time in seizure activity in progeny of an F1 intercross. We have further identified two major thalamicCacna1hsplice variants, either with or without exon 25.gcmintroduced 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.