HbA1c testing in ED targets undiagnosed diabetes, prediabetes

People with undiagnosed diabetes and prediabetes may be identified with routine HbA1c testing in the ED, according to findings of a pilot study in Australia.

Routine HbA1c testing may provide opportunities for these patients to improve their care, according to the researchers.

“Diabetes case finding in the ED is justified as there is a significant population with known and undiagnosed diabetes,” the researchers wrote. “Following the findings of this pilot, it is intended that routine HbA1c testing will be the norm in the ED at Blacktown Hospital.”

Tien-Ming Hng, MBBS, PhD, FRACP, of Western Sydney University and Blacktown Hospital in Australia, and colleagues evaluated all patients undergoing blood sampling in the ED and random blood glucose measuresover 6 weeks. HbA1c was measured on the same sample if blood glucose was at least 5.5 mmol/L. Diabetes was defined as HbA1c levels of at least 6.5%, and prediabetes was defined as HbA1c levels of 5.7% to 6.4%. Researchers identified patients with previously undiagnosed diabetes by reviewing hospital records.

Tien-Ming Hng

Tien-Ming Hng

Overall, there were 4,580 presentations to the ED and 1,267HbA1c measurements (47.3% women); 38% of participants were identified as having diabetes. Of those with diabetes, 45% were women and 32.2% were newly diagnosed.

Of participants with newly diagnosed diabetes, 61.8% had mild diabetes. Twenty-seven percent of participants with HbA1c sampled had evidence of prediabetes. The diagnosis of diabetes was not coded in 28% of participants who were known to have diabetes; 11% were previously known to have diabetes, 81% were newly diagnosed and 8% were coded as impaired glucose regulation.

“In areas of high diabetes prevalence, HbA1c screening is an effective means of findings cases of diabetes and prediabetes,” Hng told Endocrine Today. “The findings of this study provides a better understanding of the diabetes burden in our local population and its potential impact on our health resources. This allows us to plan service delivery within our local health district and the wider community; to identify individuals at risk for diabetes thus providing an opportunity for intervention to prevent them from progressing to diabetes; to identify undiagnosed patients thus resulting in earlier intervention; to recognize the population and improve management of diabetes within the hospital; and to ensure that patients admitted to the hospital are appropriately coded for the complexity of their admission.” – by Amber Cox

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