Prevalence of undiagnosed hyperglycaemia in patients presenting to the Department of Emergency Medicine with no known history of diabetes

Bar‐Dayan, Yosefa; Zilberman, Irena; Boaz, Mona; Landau, Zohar; Glandt, Mariela; Jakubowicz, Daniela; Wainstein, Julio

doi:10.1111/ijcp.12867

Cited by 9 publications

(7 citation statements)

References 26 publications

(28 reference statements)

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“…For example, in all three patients diagnosed with diabetes during their admission, this was in their discharge summaries, along with newly prescribed medications. Ideally, a request for follow-up should be found in the discharge referral of patients diagnosed with diabetes or those found to have blood glucose or HbA1c results suggestive of diabetes, and absence of such records may compromise the ability for treatment and prevention of complications [18,29,30], which may result in a higher risk of re-admission [31].…”

Section: Discussionmentioning

confidence: 99%

“…The ED also provides medical care to people with little or no access to screening and preventive interventions; therefore, initiating a screening intervention in the ED may improve the health of this vulnerable population. The ED of Campbelltown hospital of SWS serves approximately 283,743 residents across the district (ABS Census 2016) [17] and during a visit to the ED, blood glucose levels are also regularly tested particularly in high-risk individuals, making the department a potentially valuable location to conduct opportunistic screening for diabetes [12,[18][19][20]. Given the large number of presentations at the ED, missed opportunities for diabetes screening could be common [21] and patients who are newly diagnosed with diabetes from the screening test may not have been closely monitored [22].…”

Section: Introductionmentioning

confidence: 99%

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

Osuagwu

Webb

Simmons

2020

IJERPH

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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).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Osuagwu

Webb

Simmons

2020

IJERPH

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“…Clinical investigation of inpatient hyperglycaemia is infrequent, 38,39 despite high prevalence 40 and physician support for increased intervention. 41 There appears to be a lack of clinical research in this area, with only a small number of studies identified in this review.…”

Section: Summary Of Evidencementioning

confidence: 99%

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

et al. 2022

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Aim In‐hospital blood glucose testing is commonplace, particularly in acute care. In‐hospital screening for hyperglycaemia may present a valuable opportunity for early diabetes diagnosis by identifying at‐risk individuals. This systematic review investigates the extent to which random blood glucose testing in acute and inpatient hospital settings predicts undiagnosed diabetes. Methods Two databases were systematically searched for studies in which adult patients received an in‐hospital random blood glucose test, followed by a diagnostic HbA1c test. The primary outcome was the proportion of hyperglycaemic individuals diagnosed with diabetes by HbA1c. Results A total of 3245 unique citations were identified, and 12 were eligible for inclusion. Ten different blood glucose thresholds, ranging from 5.5 to 11.1 mmol/L, were used to detect hyperglycaemia, indicating that there is no consistent clinical definition for hyperglycaemia. The proportion of participants with hyperglycaemia in each study ranged from 3.3% to 62.1%, with a median (Q1, Q3) of 34.5% (5.95%, 61.1%). The proportion of hyperglycaemic participants found to have a diabetes‐range HbA1c varied from 4.1% to 90%, with a median (Q1, Q3) of 18.9% (11.5%, 61.1%). Meta‐analysis was not possible due to substantial heterogeneity between study protocols. Conclusions All studies consistently identified a proportion of hyperglycaemic hospital patients as having a diabetes‐range HbA1c, showing that in‐hospital blood glucose screening can facilitate diabetes diagnosis. The proportion of hyperglycaemic participants with undiagnosed diabetes varied substantially, indicating a need for further research and consistency in defining in‐hospital hyperglycaemia. This may aid the development of a standardised screening protocol to identify people with possible undiagnosed diabetes.

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“…Prior research demonstrates that ED diabetes surveillance protocols using only random, blood glucose measurements have been successful. [6][7][8][9][10] Patient characteristics, such as demographics, 11 body mass index (BMI), family history, comorbidities, and laboratory measures of impaired glucose tolerance, hemoglobin A1c (HbA1c), cholesterol, and triglycerides, can be used to refine a screening decision for diabetes. Confirmatory testing such as fasting plasma glucose, oral glucose tolerance testing, or HbA1C should be considered for definitive diabetes diagnosis.…”

Section: How Does This Improve Population Health?mentioning

confidence: 99%

Diabetes Patient Surveillance in the Emergency Department: Proof of Concept and Opportunities

Sava

Pirrallo

Helsel

et al. 2021

WJEM

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Introduction The purpose of this study was to characterize the at-risk diabetes and prediabetes patient population visiting emergency department (ED) and urgent care (UC) centers in upstate South Carolina. Methods We conducted this retrospective study at the largest non-profit healthcare system in South Carolina, using electronic health record (EHR) data of patients who had an ED or UC visit between February 2, 2016–July 31, 2018. Key variables including International Classification of Diseases, 10th Revision codes, laboratory test results, family history, medication, and demographic characteristics were used to classify the patients as healthy, having prediabetes, having diabetes, being at-risk for prediabetes, or being at-risk for diabetes. Patients who were known to have diabetes were classified further as having controlled diabetes, management challenged, or uncontrolled diabetes. Population analysis was stratified by the patient’s annual number of ED/UC visits. Results The risk stratification revealed 4.58% unique patients with unrecognized diabetes and 10.34% of the known patients with diabetes considered to be suboptimally controlled. Patients identified as diabetes management challenged had more ED/UC visits. Of note, 33.95% of the patients had unrecognized prediabetes/diabetes risk factors identified during their ED/UC with 87.95% having some form of healthcare insurance. Conclusion This study supports the idea that a single ED/UC unscheduled visit can identify individuals with unrecognized diabetes and an at-risk prediabetes population using EHR data. A patient’s ED/UC visit, regardless of their primary reason for seeking care, may be an opportunity to provide early identification and diabetes disease management enrollment to augment the medical care of our community.

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Prevalence of undiagnosed hyperglycaemia in patients presenting to the Department of Emergency Medicine with no known history of diabetes

Cited by 9 publications

References 26 publications

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

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

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

Diabetes Patient Surveillance in the Emergency Department: Proof of Concept and Opportunities

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