Contemporary practices of blood glucose management in diabetic patients: a survey of hyperbaric medicine units in Australia and New Zealand

Introduction: Blood glucose levels may be influenced by hyperbaric oxygen treatment (HBOT). Patients with diabetes mellitus commonly receive HBOT but there is a lack of standardised blood glucose management guidelines. We documented relevant contemporary practices applied for patients with diabetes treated in hyperbaric medicine units. Methods: A survey was administered in 2022 to the directors of all 13 accredited hyperbaric units in Australia and New Zealand to identify policies and practices related to management of patients with diabetes receiving HBOT. Results: Twelve of the 13 units routinely managed patients with diabetes. Three-quarters (9/12) used < 4 mmol·l-1 as their definition of hypoglycaemia, whereas the other three used < 5, < 3.6, and < 3 mmol·l-1. Units reported 26% (range 13–66%) of their patients have a diagnosis of diabetes of which 93% are type 2. Ten (83%) units reported specific written protocols for managing blood glucose. Protocols were more likely to be followed by nursing (73%) than medical staff (45%). Ten (83%) units routinely tested blood glucose levels on all patients with diabetes. Preferred pre-treatment values for treatments in both multiplace and monoplace chambers ranged from ≥ 4 to ≥ 8 mmol·l-1. Seven (58%) units reported continuation of routine testing throughout a treatment course with five (42%) units having criteria-based rules for discontinuing testing for stable patients over multiple treatments. Two-thirds of units were satisfied with their current policy. Conclusions: This survey highlights the burden of diabetes on patients treated with HBOT and identifies considerable variability in practices which may benefit from further study to optimise management of these patients.