Background. Screening inpatients for diabetes mellitus may be a good opportunity to detect undiagnosed cases and several studies have demonstrated the feasibility and usefulness of this practice. HbA1c has been suggested as the method of choice due to the effects of acute illness on glucose. The aim of this study was to evaluate a screening protocol based on HbA1c to identify inpatients with undiagnosed diabetes mellitus in an internal medicine department. Methods. We conducted a prospective study of all admissions in the internal medicine department of a 412-bed community hospital in Greece during a 6-month period. Candidates for screening based on the American Diabetes Association’s recommendations were screened with HbA1c. Patients with very poor health status and patients with conditions that may interfere with HbA1c measurement or interpretation were excluded. Results. Of 463 patients (median age 74) only a small proportion (14.9%) were candidates for screening with HbA1c. Known diabetes mellitus, a low admission glucose, severe anemia or blood loss and poor health status were the most common reasons of exclusion. Among the 55 screened patients, 7 had diabetes (based on HbA1c ≥ 6.5%). However, in only 1 of them HbA1c was above target considering the patients’ health status. Categorical agreement (no diabetes, prediabetes, diabetes) between morning glucose and HbA1c was low. However, the concordance between a morning glucose < 125 mg/dl and HbA1c < 6.5% was > 90%. Conclusions. In settings similar to ours (very elderly patients, high rate of conditions that confound the use of HbA1c and high rate of patients with poor health status), untargeted screening of inpatients with HbA1c is unlikely to be cost-effective. A morning glucose during hospitalization may be a better first step for screening.

Funding Acknowledgements Type of funding sources: None. Introduction Hospitalization due to acute coronary syndromes (ACS) usually is the occasion that leads to diagnosis of type 2 diabetes mellitus (T2DM). Current literature suggests that the severity of the ACS could be associated with the presence and the severity of DM. Purpose To study the reliability of HbA1c in the diagnosis of T2DM in the acute phase of ACS, as well as the presence of possible correlation between the HbA1c and the severity of ACS. Methods We evaluated 160 consecutive patients admitted due to ACS. HbA1c was measured on day 1 and day 90. HbA1c &gt;6.5% was used to diagnose T2DM and HbA1c 5.7-6.4% was used to diagnose pre-diabetes. The severity of ACS was assessed via Gensini score. Results are interpreted as mean ± SD. Comparisons were made by one way ANOVA(p &lt; 0.05 was regarded statistically significant).Spearman’s rank correlation was used to study the correlation between Gensini score and the other parameters. Results Mean age was 59.73 ± 12.21 years. 103/160(64.37%) were male and 57/160(35.63%) were female. 19/160(11.87%) were diagnosed as STEMI and 141/160(88.13%) as NSTEMI. Mean BMI was 29.55 ± 8.41 kg/m2 and mean Hb 12.62 ± 2.08 g/dl. On day 1, 43/160 (26.87%) had HbA1c &gt; 6.5% and 41/160(25.62%) HbA1c 5.7-6.4%. On day 90, 28/160 (17.5%) had HbA1c &gt; 6.5% and 52/160(32.5%) HbA1c 5.7-6.4%. Gensini score varied between 0-144 with mean value 40.26 ±35.9. A strong correlation was found between Gensini score and HbA1c on admission as well as on day 90 (rho-0.36, p &lt; 0.05 and rho = 0.32, p &lt; 0.05 respectively). Conclusion HbA1c seems to be reliable in the identification of pre-diabetes but not T2DM in the acute phase of ACS. The correlation of the severity between ACS and HbA1c seems to relate with the worst prognosis of T2DM patients.

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Funding Acknowledgements Type of funding sources: None. Introduction Heart failure with preserved ejection fraction (HFpEF) has become a common cause of visiting the emergency department (ED). Type 2 diabetes mellitus (T2DM) is one of the important predisposing factors. Purpose To study the prevalence of undiagnosed pre-diabetes or T2DM in the patients visiting the ED due to HFpEF. Methods 93 consecutive patients without known history of T2DM visited the ED with signs and symptoms of heart failure. Left ventricular ejection fraction (LVEF) was calculated using bedside ECHO. LVEF &gt; 50% was used to classify HFpEF patients. HbA1c was measured to all patients and the cutoff for T2DM was HbA1c &gt; 6.5% and for pre-diabetes 5.7-6.4%. Body mass index (BMI), brain natriuretic peptide (BNP) , creatinine  and  hemoglobin (Hb) were also recorded. Results are interpreted as mean ± SD. Results Mean age was 56 ± 11.8 years. 64/93 (68.8%) were female and 29/93(26.97%) male. Mean BMI was 36.52 ± 7.34 kg/m2 and mean Hb 13.51 ± 3.45 g/dl. Mean BNP was 584.82 ± 212.97 pg/ml. Mean creatinine was 1.11 ± 0.36mg/dl. 19/93 (17.67%) patients had HbA1c &gt; 5.7-6.4% and were classified as pre-diabetics and 23/93(21.93%) had HbA1c &gt; 6.5% and were classified as diabetics. We did not identify any correlation between the rest of the parameters. Coclusion 44.64% of the patients that visited ED due to signs or symptoms of HFpEF were identified as having either pre-diabetes or T2DM. Taking into consideration the importance of the presence of T2DM in the prognosis of the patients with HFpEF, it would be reasonable to screen all patients with HFpEF for T2DM and suggest specialized treatment.