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Prevalence of hypoglycaemic episodes declines in hospitals, according to diabetes inpatient audit

8 March 2017: The prevalence of all hypoglycaemic episodes in hospital, both mild and severe, has decreased from 26 per cent in 2011 to 20 per cent in 2016.

Regional information is available from this audit

Mild hypoglycaemia has fallen by five percentage points, from 23 per cent in 2011 to 18 per cent in 2016. Severe hypoglycaemia, which is more serious because it can cause loss of consciousness, has fallen from 11 per cent in 2011 to eight per cent in 2016.

The 2016 National Diabetes Inpatient Audit report (NaDIA), published today by NHS Digital, also shows that there has been an overall reduction in the prevalence of the most severe, life-threatening hypoglycaemia which requires injectable rescue treatment for inpatients with diabetes5. This has fallen from 2.2 per cent in 2011 to 1.7 per cent in 2016.

Other findings in the report show:

  • A decrease in the proportion of inpatients on intravenous insulin infusions (IVII) (11 per cent in 2011 to 8 per cent in 2016) and a decrease in the proportion of patients receiving excessively long insulin infusions (8 per cent in 2011 to 6 per cent in 2016).
  • A reduction in the mismanagement of transfers from intravenous to injectable insulin, down from 19 per cent in 2011 to 14 per cent in 2016.
  • A reduction of 0.9 percentage points in the proportion of inpatients in England6 who develop a foot lesion during their hospital stay (2.2 per cent in 2010 to 1.3 per cent in 2016)

The NaDIA measures the quality of diabetes care provided to people who are admitted to hospital, and covers issues such as staffing levels, medication errors, patient harms and patient experience. There were 209 sites in England and Wales participating in the 2016 survey and data was submitted for 15,774 inpatients - 500 more than in 2015 (15,229).

The audit is carried out by NHS Digital, in collaboration with Diabetes UK7 and commissioned by the Healthcare Quality Improvement Partnership8 (HQIP) as part of the National Clinical Audit Programme.

Other findings in the 2016 NaDIA include:

Hospital stay

  • One in six hospital beds (17 per cent) were occupied by a person with diabetes in 2016. This figure has risen each year since 2011, when it was 15 per cent
  • In 2016, 69 per cent of inpatients with diabetes were seen by a member of the diabetes team where appropriate9, up from 58 per cent in 2011
  • 28 per cent of hospitals don't have specialist nurses to support inpatients with diabetes

Inpatient-onset hyperglycaemic emergency

  •  Around one in 25 inpatients with Type 1 diabetes (four per cent) developed the life-threatening and preventable condition diabetic ketoacidosis (DKA) during their hospital stay in 2016. There has been no significant change since 2011 when it was three per cent
  •  In 2016, around one in 500 inpatients with Type 2 diabetes (0.2 per cent) developed hyperosmolar hyperglycaemic state (HHS) during their hospital stay. This figure remains unchanged since 2015 when recording of this life-threatening and preventable condition began.

Medication Errors10

  •  The proportion of inpatient drug charts that had at least one medication error has decreased only slightly from 40 per cent in 2011 to 38 per cent in 2016, continuing to affect almost two out of five inpatient drug charts
  •  In 2016, inpatient drug charts were more likely to contain medication errors if the inpatient was treated on a surgical ward (41 per cent) compared to a medical ward (37 per cent)
  •  Prescription errors were less likely to occur if inpatients were treated in a hospital that used an Electronic Patient Record (EPR) (19 per cent) compared to hospitals that did not use EPR (25 per cent)

Patient satisfaction

  •  In 2016, five out of six patients were satisfied or very satisfied with their diabetes care during their hospital stay (84 per cent), which has remained at a similar level since 2011
  •  Inpatient satisfaction with meal choice has declined, from 64 per cent in 2011 to 54 per cent in 2016
  •  Inpatient satisfaction with meal timing has also declined from 70 per cent in 2011 to 63 per cent in 2016

Audit lead clinician, Dr Gerry Rayman11, said:

"The audit continues to play an important role in changing the standards of hospital care for patients with diabetes and driving forward changes that can save lives, improve inpatient experiences and save money for hospital trusts.

"We have seen a number of successes which include falls in the instances of hypoglycaemic episodes, unnecessary insulin infusions and hospital-acquired foot ulcers. These are, in part, due to the take up of new and more efficient ways of working. The number of hospital sites with care improvement initiatives such as Electronic Patient Records and Electronic Prescribing has increased since 2013, and diabetes Mortality and Morbidity meetings are now held in 53 per cent of sites.

"Each year, we have seen inpatient numbers increasing steadily and, today, around a third of inpatients in a few hospitals have diabetes. There has been little change in staffing levels to accommodate this rise and while overall satisfaction with care is high, the audit shows that there is more work to be done. The audit is stimulating people to ask questions about their hospital care which will also help to drive forward improvements.

"Improvements in medicine management, identifying those at risk, educating other health care professionals and implementing best practice will be a focus for specialist teams within hospitals who are committed to delivering an excellent service to patients with diabetes, despite the many demands upon them."

"While we can celebrate the achievements of the NaDIA, we must continue to focus on reducing preventable and serious complications including severe hypoglycaemia, hospital acquired foot ulceration, diabetic ketoacidosis and hyperosmolar hyperglycaemic state."

Read the full report:


Notes to editors

  1. NHS Digital is the national information and technology provider for the health and care system. Our team of information analysis, technology and project management experts create, deliver and manage the crucial digital systems, services, products and standards upon which health and care professionals depend. Our vision is to harness the power of information and technology to make health and care better. NHS Digital is the new trading name for the Health and Social Care Information Centre (HSCIC). We provide 'Information and Technology for better health and care'. Find out more about our role and remit at
  2. Hospital staff were asked to report on the number of hypoglycaemic blood sugar readings on the patient's chart within the seven days up to the day of the audit. If the patient had been in hospital for less than seven days then the number of readings for the total period of the hospital stay was reported. For the purpose of this audit, mild hypoglycaemia was defined as capillary blood glucose of between 3.0 - 3.9mmol/L and severe hypoglycaemia was defined as capillary blood glucose of less than 3.0mmol/L. 18.5 per cent of inpatients had one or more mild hypoglycaemic episodes and 8.4 per cent had one or more severe episodes. 20.0 per cent of inpatients had one or more hypoglycaemic episode (mild and/or severe).
  3. Trends reported in the press release have been tested for statistical significance at the 0.05 level, meaning that there is only a 5 per cent probability that the result is due to chance.
  4. The majority of comparisons are with 2011, the first NaDIA covering both England and Wales. Exceptions are made when the measure has not been collected for the whole period (e.g. HHS) or in other specific circumstances (e.g. foot lesions - see note 6).
  5. Diabetes comprises a group of disorders with many different causes, all of which are characterised by a raised blood glucose level. This is the result of a lack of the hormone insulin and/or an inability to respond to insulin. Insulin in the blood, produced by the pancreas, is the hormone which ensures that glucose (sugar) obtained from food can be used by the body. There are two main types of diabetes: Type 1 diabetes and Type 2 diabetes.
  6. Wales did not submit to the 2010 NaDIA. England and Wales combined data on foot lesions is only available from 2012 onwards, with no significant differences found between 2012 and 2016.
  7. Diabetes UK is the leading UK charity that cares for, connects with and campaigns on behalf of all people affected by or at risk of diabetes. It helps people manage their diabetes effectively by providing information, advice and support. Diabetes UK campaigns with people with diabetes and with healthcare professionals to improve the quality of care across the UK's health services. It funds pioneering research into care, cure and prevention for all types of diabetes. It works to stem the rising tide of Type 2 diabetes - through risk assessment, early diagnosis, and by communicating how healthy lifestyle choices can help many people avoid or delay its onset.
  8. The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the National Clinical Audit Programme, comprising more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands.
  9. Assessment of whether a patient should be seen by a member of the specialist diabetes team was made using the NHS Institute for Innovation's 'Think Glucose Criteria'
  10. The most common medication errors were insulin or an oral hypoglycaemic agent (OHA) not being increased when blood glucose was persistently high. Other recorded errors included staff failing to note that they had given diabetic medications, medications being given or prescribed at the wrong time and medications not being reduced when appropriate.
  11. Dr Gerry Rayman is Consultant Physician and Head of Service at the Diabetes and Endocrine Centre at Ipswich Hospital NHS Trust.
  12. For media enquiries to Diabetes UK, please call 0207 424 1165 or email
  13. For media queries or interview requests please contact or telephone 0300 30 33 888.
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