It’s not news to those with diabetes that hospitals are scary places that will quite likely do you more harm than good.
A UK audit of the treatment of inpatients with diabetes found:
“Hospital inpatients with diabetes are developing potentially life-threatening complications at a “shocking” rate,
The National Diabetes Inpatient Audit (NaDIA) found that, in a five-day period, more than 60 people with diabetes developed diabetic ketoacidosis (DKA), which results from a severe shortage of insulin. … Even a single case of DKA developing in hospital is unacceptable because it suggests that insulin has been withheld from that person for some time. The fact that this is regularly happening raises serious questions about the ability of hospitals to provide even the most basic level of diabetes care….
The report also found that the majority of hospitals in the survey made medication errors, with more than a third of inpatients experiencing a medication error during the period of the study.” A good summary of the findings can be found here. UK National Diabetes Inpatient Audit
In case you think things are any better in Australia, think again. Sadly we don’t have anything as comprehensive as the UK’s NaDIA but a small study of one Melbourne Tertiary Hospital found
There doesn’t seem to be any reason not to assume that this error rate is repeated across many hospitals and given that the hospital in question is a teaching hospital and has access to diabetes specialist nurses, dietitians and endocrinologists, it is likely that smaller and regional hospitals would have worse rates of error.
So in Australia, you are more likely than not to suffer a medical error in the management of your diabetes in hospital. Scary!
So that’s some of the empirical evidence. When you start analysing people’s experiences with diabetes in hospital it gets even scarier. Withholding insulin despite established, documented type 1 diabetes and the presence of high sugars is commonplace. Anecdotes shared on social media sll too frequently include teenagers with diabetic ketoacidosis being told they should be refused treatment if they come in for a second time, medical staff talking loudly of “another bad diabetic clogging up our ER”, not having hypo treatments available, hypos being ignored by staff and routine ignoring of out of range blood sugar levels.
Diabetes is a very common disease and the NaDia study indicated that during the study, 15% or 1 in 7 hospital beds were occupied by people with diabetes. So it’s not as though diabetes is so rare people haven’t come across it before or that it wouldn’t be covered in med/nursing school.
So what are the causes of such an alarming rate of medical error? I am sure that there are a great many reasons and a combination of factors that give rise to medical errors and poor treatment but I am putting forward the hypothesis that stigma is at least partially to blame for the poor treatment of people with diabetes.
This suggestion might raise some hackles but is it any more outrageous than the fact that people with diabetes in Australia are more likely to suffer a medical error than not and in the UK, it’s not much better with 40% of people with diabetes suffering an error and alarmingly, 7% of type 1 diabetes patients experienced DKA as a result of their hospital admission. Those are some startling statistics. Further research is required to provide data on error rates amongst different conditions and to examine the attitudes of HCPs towards diabetes.
Is it possible that the perception of diabetes as a self-inflicted disease in which any problems, be they blood sugar-related or long-term complications are self-inflicted translates to a belief that people with diabetes are less worthy of medical care than more deserving patients? Certainly, this sentiment has been overtly expressed to people with diabetes by health professionals.
It makes sense to me that beliefs do get translated into actions even if it’s entirely subconsciously. I don’t believe HCPs make deliberate decisions to harm people with diabetes but isn’t it possible that those messages about non-compliance, avoiding diabetes by losing weight, poor control, the need to improve diet and “clogging up the ER” translate into diabetes being treated as a low priority rather than the life-threatening condition it is?
What do you think? Could stigma be killing us? What can be done to improve treatment of diabetes in hospital and/or stigma?