The prevalence of diabetes in hospital has doubled over the last two decades and currently affects 1 in 4 inpatients, placing a great burden on the health system. Observational studies show that inpatients with diabetes have greater risk of hospital complications including increased mortality, longer length of stay and higher readmission rates.

Furthermore, independent of diabetes, the presence of hyperglycaemia and hypoglycaemia are associated with hospital complications especially nosocomial infections, acute kidney injury, myocardial ischaemia and mortality. Postulated mechanisms include impaired immune function, endothelial dysfunction, inflammation, delayed wound healing, osmotic diuresis and increased risk of thrombosis. This association is seen in severe illness such as acute myocardial infarct, stroke and critical care, as well as in general ward and perioperative settings. Although association does not prove causality, avoidance of hypoglycaemia and significant hyperglycaemia is recommended in hospitalised patients. 

Despite published recommendations, audits show that inpatient glycaemia remains suboptimally managed with ongoing high rates of hypoglycaemia, hyperglycaemia, medication errors and patient dissatisfaction. There are multiple barriers to optimal inpatient diabetes management. These include heterogeneous patient physiology, variable staff practices and attitudes, dynamic hospital processes, and inconsistent infrastructure and support. Efforts to improve inpatient diabetes care should address these multiple barriers.