Diabetes Detection and Communication among Patients Admitted through the Emergency Department of a Public Hospital

Abstract

Early identification/diagnosis of diabetes and frequent monitoring of hyperglycemia reduces hospitalizations and diabetes-related complications. The present study investigated the proportion of older adults coded with diabetes or newly diagnosed during their admissions and assessed discharge summary content for diabetes-related information. The study used electronic data on 4796 individuals aged ≥60 years admitted through the emergency department (ED) of a public hospital from 2017 to 2018 extracted using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM code). The proportion of admitted patients who were diagnosed with diabetes over a one-year period, proportion with glycated hemoglobin A1c (HbA1c) and random blood glucose (RBG) test performed during their stay, length of stay, discharge summary information and the factors associated with elevated HbA1c (>7%/53 mmol/mol) were investigated. In total, 8.6% of ED presentations to the hospital were coded with diabetes, excluding gestational consisting of 879 patients (449 males, 430 females) aged ≥ 60 years (74.6 ± 8.9 years). In total, 98% had type 2 diabetes (n = 863), 53% were Australian-born (n = 467), and the mean body mass index (BMI, 31 ± 7 kg/m2; n = 499, 56.8%), RBG (9.8 ± 5.2 mmol/L; n = 824, 93.7%) and HbA1c (8.0 ± 2.0%; n = 137, 15.6%) and length of stay (6.7 ± 25.4 days) were similar between gender, age, and nationality (p > 0.05). Three coded patients (0.3%) were newly diagnosed during the admission. In total, 86% had elevated HbA1c, but this was recorded in 20% of discharge summaries. Patients who are on a combination therapy (adjusted odds ratio 23%, 95% confidence intervals: 7%/38%), those on SGLT2 Inhibitors (aOR, 14%: 2%/26%) or had a change in medication (aOR, 40%: 22%/59%) had lower odds of having elevated HbA1c during admission. The low diagnosis rate of diabetes and the lack of clinical assessment of HbA1c in older adults admitted through the ED of a South Western Sydney public hospital suggest that many patients with diabetes either remain undiagnosed even during admission and/or are going to the ED with unknown diabetes that is unidentified with current practices. The clinically important HbA1c results were only infrequently communicated with general practitioners (GPs).

Analysis of in-hospital mortality among people with and without diabetes in South Western Sydney public hospitals (2014–2017)

“…This was similar to the findings of a systematic review and meta-analyses, which determined that diabetes is associated with an increased mortality risk in cardiac surgery patients admitted to ICU [40] and this may be related to the high blood glucose levels in ICU [39]. Although at the time of this study, HbA1 c has been recommended for use as a diagnostic test for diabetes in Australia [41], it was still not commonly performed during admission across SWSL HD hospitals particularly among older participants [42]. Similar to previous studies, [12-14, 32, 33] we found significant associations between comorbidities affecting the respiratory and circulatory systems and increased odds of death in people with and without diabetes.…”

“…To understand the effect of polymorbidity on the mortality rates, we categorized the number of comorbidities into primary admission diagnosis plus either one comorbidity, or two/more comorbidities. Hospital admission included the length of stay (categorised as </= 4 days and > 4 days) [ 25 , 26 ] in hospital and whether or not there was an ICU admission.…”

Sex-related disparities in the incidence and outcomes of infective endocarditis according to type 2 diabetes mellitus status in Spain, 2016–2020

“…This last option means that T2DM was diagnosed during the hospitalization. However, in our study population very few patients had T2DM diagnosed when admitted with IE (< 1%), this agrees with studies conducted in other countries [ 52 ]. Seventh, in Spain the use of outpatient parenteral antibiotic treatment (OPAT) for IE has been implemented in some hospitals, even if the proportion of patient who undergo this therapy is low [ 53 ].…”

The potential for utilising in‐hospital glucose measurements to detect individuals at high risk of previously undiagnosed diabetes: Retrospective cohort study

“…Of the population, 70.7% of individuals declared themselves to be of White ethnicity, 3.1% of Asian background and 1.1% of Black background, with 23.1% unstated. The median number of admissions was 2, 1,3 and median length of admission was 1.3 (0.3, 3.5) days.…”

“…Many people with undiagnosed diabetes have hyperglycaemia when they are admitted to hospital. [1][2][3] There is no accepted systematic process of diagnosing diabetes within this population although there is evidence that undiagnosed diabetes is more prevalent in hospital inpatients than the general population. 4 Inpatient hyperglycaemia can be an indication of diabetes mellitus but can also indicate a stress response.…”