Prevalence of hyperglycaemia without previously recognised diabetes mellitus in the emergency department and subsequent management: a retrospective cross‐sectional study

Abstract

Background: Australian hospital data on hyperglycaemia without previously known diabetes are lacking. Aims: To determine the prevalence of hyperglycaemia without previously recognised diabetes among all patients screened in the emergency department (ED). Secondary aims are to describe the extent of haemoglobin A1c testing for evaluation of new diabetes, adequate glucose monitoring, treatment of significant hyperglycaemia and documented follow-up plans. Methods: Patients presenting to ED at the Alfred (tertiary hospital in Melbourne) have undergone screening random plasma glucose (RPG) with their first plasma biochemistry since 2015. Of the 16 268 adults screened from July to December 2015, a retrospective, cross-sectional study was undertaken evaluating those with hyperglycaemia (RPG >7.8 mmol/L) but without previously recognised diabetes as determined from coding data. After patient records were reviewed to correct for coding errors, a nested cohort of 200 such patients were further evaluated. Glucose monitoring was deemed adequate if undertaken for ≥48 h. Significant hyperglycaemia (RPG >11 mmol/L) was considered appropriately treated if insulin/hypoglycaemic agents were prescribed. Documented follow-up plans were acceptable if found in the discharge summary. Results: Among all patients screened, 1178 had hyperglycaemia without coded diabetes. After adjusting for coding errors, the prevalence was 5.2%. Within the nested cohort, only 7.5% had a follow-up haemoglobin A1c ordered, 9.5% underwent adequate glucose monitoring, 6.5% had appropriate treatment of significant hyperglycaemia and 2% had documentation of a follow-up plan. Conclusions: Hyperglycaemia without previously recognised diabetes is commonly seen and justifies ED screening. However, management of newly detected hyperglycaemia in these patients is suboptimal and requires improvement.

Assessment of glycaemic status in adult hospital patients for the detection of undiagnosed diabetes mellitus: A systematic review

“…36 Ethnicity was not reported for seven out of 12 studies. 25,[29][30][31][33][34][35] Out of five studies reporting participants' mean age, 26,27,29,32,33 the highest was 67 years, 27 and the lowest was 50.6 years. 33 Four publications reported median age, 31,[34][35][36] and two gave no information.…”

“…25,26,28,29,31,32,34,36 Four were set in public or community hospitals, 30,33,35,36 and one in an acute care general hospital. 27 Out of 12 studies, seven included only ED patient populations, 25,26,[28][29][30][31]36 two screened all hospital admissions 27,32 and three included individuals from a combination of ED, surgical and/or medical wards. [33][34][35] Exclusion criteria were generally consistent, although notable exceptions are discussed below.…”

“…Pregnancy, an existing diabetes diagnosis, age <18 years, and emergency and trauma status were common reasons for exclusion. The proportion of individuals excluded due to a prior diabetes diagnosis ranged from 9.4% 29 to 73% 34 …”

“…The main limitations are highlighted by the heterogeneity between included studies, which is reflected in the QUADAS‐2 assessment. Only one study was low risk for both bias and applicability, 32 while a further two were low risk for only bias 34 or applicability 29,30 …”

“…We found considerable between-study heterogeneity for the index testing protocols and results. Of 12 studies, seven measured blood glucose in ED, 25,26,[28][29][30][31]36 used blood samples drawn as part of routine inpatient clinical care, 27,32 one used the first available morning blood glucose sample 35 and one used a pre-operative sample. 33 One study did not specify when the sample was obtained.…”