Evaluating the Diabetes-Cardiology interface: a glimpse into the diabetes management of cardiology inpatients in western Sydney's 'diabetes hotspot' and the establishment of a novel model of care

Ramy H Bishay; Gideon Meyerowitz-Katz; David Chandrakumar; Rajini Jayaballa; Tien-Ming Hng; Mark Mclean; Dilini Punchihewa; Maiyoori Jeyaprakash; David Burgess; John Riskallah; Glen F Maberly

doi:10.1186/s13098-018-0393-7

Evaluating the Diabetes-Cardiology interface: a glimpse into the diabetes management of cardiology inpatients in western Sydney's 'diabetes hotspot' and the establishment of a novel model of care

Diabetol Metab Syndr. 2018 Dec 14:10:90. doi: 10.1186/s13098-018-0393-7. eCollection 2018.

Authors

Ramy H Bishay^{1

2

3

4

5}, Gideon Meyerowitz-Katz¹, David Chandrakumar¹, Rajini Jayaballa¹, Tien-Ming Hng^{1

2

5}, Mark Mclean^{1

2}, Dilini Punchihewa¹, Maiyoori Jeyaprakash¹, David Burgess^{2

6}, John Riskallah⁶, Glen F Maberly^{1

2

3}

Affiliations

¹ 1Western Sydney Diabetes, Integrated and Community Health Directorate, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW Australia.
² 2School of Medicine, Western Sydney University, Sydney, NSW Australia.
³ 3School of Medicine, University of Sydney, Sydney, NSW Australia.
⁴ 5Metabolic and Weight Loss Program, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW Australia.
⁵ 6Department of Endocrinology, Clinical School Building, Level 3, Western Sydney University Blacktown Campus, Blacktown Hospital, Marcel Crescent, Blacktown, NSW 2148 Australia.
⁶ 4Department of Cardiology, Blacktown Hospital, Blacktown, NSW Australia.

Abstract

Background: Approximately two-thirds of individuals presenting to emergency departments in Western Sydney have glucose dysregulation, accelerating their risk of cardiovascular disease (CVD). We evaluated the prevalence and management of type 2 diabetes (T2D) in cardiology inpatients in Western Sydney. A novel model of care between diabetes and cardiology specialist hospital teams (joint specialist case conferencing, JSCC) is described herein and aimed at aligning clinical services and upskilling both teams in the management of the cardiology inpatient with comorbid T2D.

Methods: Cardiology inpatients at Blacktown-Mount Druitt Hospital were audited during a 1-month period.

Results: 233 patients were included, mean age 64 ± 16 years, 60% were male, 27% overweight and 35% obese. Known T2D comprised 36% (n = 84), whereas 6% (n = 15) had a new diagnosis of T2D, of which none of the latter were referred for inpatient/outpatient diabetes review. Approximately, 27% (n = 23) and 7% (n = 6) of known diabetes patients suffered hyper- and hypoglycaemia, respectively, and 51% (n = 43) had sub-optimally controlled T2D (i.e. HbA1c > 7.0%); over half (51%, n = 51) had coronary artery disease. Only two patients were treated with an SGLT2 inhibitor and no patients were on glucagon like peptide-1 receptor analogues. The majority were managed with metformin (62%) and therapies with high hypoglycaemic potential (e.g., sulfonylureas (29%)) and in those patients treated with insulin, premixed insulin was used in the majority of cases (47%).

Conclusions: Undiagnosed T2D is prevalent and neglected in cardiology inpatients. Few patients with comorbid T2D and CVD were managed with therapies of proven cardiac and mortality benefit. Novel models of care may be beneficial in this high-risk group of patients and discussed herein is the establishment of the diabetes-cardiology JSCC service delivery model which has been established at our institution.

Keywords: Cardiovascular disease; Cardiovascular mortality; GLP-1 receptor analogues; Health care delivery; Hypoglycaemia; In-patient diabetes; Incretin therapies; Ischaemic heart disease; Obesity; SGLT-2 inhibitors.