Postgraduate doctors in training’s limited knowledge and practice in the assessment and management of inpatients with diabetes and frailty may contribute to suboptimal outcomes

Abstract

Introduction:

People with diabetes and frailty require less intensive treatment of hyperglycaemia. Previous study has shown low rates of HbA_1c assessment and deintensification for people with diabetes and frailty. Postgraduate doctors in training (PGDiT) is important in the inpatient management of people with diabetes and frailty. This study aims to assess the knowledge and management practice amongst PGDiT in managing people with diabetes and frailty and how this may translate to patients’ clinical outcomes.

Methods:

Three cross-sectional survey-based studies were conducted on PGDiT at the beginning of each 4-month rotation. Survey questions incorporated knowledge of HbA_1c goals and on PGDiT deintensification practice in people with diabetes and frailty who are overtreated with blood glucose-lowering medication. These were coupled by two cross-sectional data collection on patients’ outcomes conducted during the same period including HbA_1c assessment and rates of deintensification.

Results:

PGDiT survey: 160 PGDiT responded to the survey. 80.0% (n = 128/160) of PGDiT reported that they knew the target HbA_1c in patients with diabetes and frailty. However, only 32.8% (n = 42/128) of these correctly indicated the target HbA_1c for such patients. PGDiT deintensification practices were lower than expected and several barriers of inpatient deintensification were identified. Patients’ clinical outcomes: 198 patients with diabetes and moderate-severe frailty were included in our analysis (median (interquartile range, IQR) age 80 (71–87) years with median (IQR) clinical frailty scale of 6 (6–7)). For patients who did not have their HbA_1c assessed in the last 6 months preceding admission, only 18.1% (n = 13/72) had it assessed during admission. In patients who are overtreated, deintensification rate was 29.7% (n = 22/74).

Conclusion:

Our audit shows limited knowledge and management practices amongst PGDiT in the management of inpatients with diabetes and frailty that may contribute to low inpatient deintensification rate. Interventions are needed to improve patient outcomes and a model of care consisting of appropriate inpatient multidisciplinary team input to reduce treatment inertia.