E-Poster Presentation ESA-SRB-ANZBMS 2021

Diabetes complications and comorbidity screening in patients hospitalised with diabetes-related foot disease (#316)

Lipi Chakravorty 1 , Michael Mccann 2 , Wendy Davis 3 , P. Gerry Fegan 1 4 , Emma Hamilton 1 3 5 6
  1. Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Murdoch, WA, Australia
  2. Department of Cardiology, Fiona Stanley Hospital, Murdoch, WA, Australia
  3. University of Western Australia, Medical School, Fremantle Hospital, Fremantle, Australia
  4. Faculty of Health Sciences, Curtin University, Perth, WA, Australia
  5. University of Western Australia, Medical School, Fiona Stanley Hospital, Murdoch, Australia
  6. Multidisciplinary Diabetes Foot Unit, Fiona Stanley and Fremantle Hospitals, Perth, WA, Australia

Background: Diabetes-related foot disease (DFD) is the leading cause of hospitalisation amongst people with diabetes. The Multidisciplinary Diabetes Foot Unit (MDFU) at Fiona Stanley Hospital provides interdisciplinary care for hospitalised patients with DFD. These patients also have significant risks of cerebrovascular, cardiovascular and renal disease and since 2019, we have adopted a simple written inpatient guideline with instructions on diabetes complication screening and the use of cardioprotective medications based on the American Diabetes Society Standards of Care. These guidelines were distributed to all members of the MDFU team including the rotating groups of junior doctors at the beginning of each term along with educational sessions on the implementation of these guidelines.

Aim: Our objective was to determine if the guideline improved screening for diabetes complications and the use of cardioprotective medications in patients admitted to MDFU.

Methods: We conducted an observational, retrospective study of patients admitted to MDFU comparing two 6-month periods, prior to and following the introduction of the guideline.

Results: 84 patients were studied in the first 6-month period and 138 patients were studied in the second 6-month period. HbA1c was measured in most patients in both phases (90.5% vs 95.7%, P=0.156). Following implementation of the guideline, there was no difference in screening of urine ACR (33.3% vs 21.0%, P=0.057) or lipid profile (53.6% vs 40.6%, P=0.071). Prescription of cardioprotective medications including statin therapy and renin-angiotensin aldosterone blockade was common in both groups but remained unchanged between phases.

Conclusion: Despite the introduction of the guideline, there was no improvement in opportunistic screening or use of cardioprotective medications in patients hospitalised with DFD, highlighting the challenges of inpatient screening. More research is required to identify strategies to improve opportunistic diabetes complication screening and cardiovascular risk management of this complex and high risk patient group.

611e252742762-Table+1..jpg