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Clinical care/education/nutrition/psychosocial research
Diabetes case finding in the emergency department, using HbA1c: an opportunity to improve diabetes detection, prevention, and care
  1. Tien-Ming Hng1,2,
  2. Amanda Hor1,3,
  3. Sumathy Ravi1,
  4. Xiaoqi Feng1,3,4,
  5. Jaime Lin1,
  6. Thomas Astell-Burt5,6,
  7. David Chipps1,
  8. Mark McLean1,2,
  9. Glen Maberly1,2
  1. 1Western Sydney Local Health District, Blacktown Hospital, Blacktown, New South Wales, Australia
  2. 2School of Medicine, Western Sydney University, Parramatta, New South Wales, Australia
  3. 3School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
  4. 4Early Start Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
  5. 5School of Science and Health, Western Sydney University, Parramatta, New South Wales, Australia
  6. 6School of Geography and Geosciences, University of St Andrews, St Andrews, UK
  1. Correspondence to Dr Tien-Ming Hng; tien-ming.hng{at}health.nsw.gov.au

Abstract

Objective We assessed the efficacy of routine glycated hemoglobin (HbA1c) testing to detect undiagnosed diabetes and prediabetes in an urban Australian public hospital emergency department (ED) located in an area of high diabetes prevalence.

Methods Over 6 weeks, all patients undergoing blood sampling in the ED had their random blood glucose measured. If ≥5.5 mmol/L (99 mg/dL), HbA1c was measured on the same sample. HbA1c levels ≥6.5% (48 mmol/mol) and 5.7–6.4% (39–46 mmol/mol) were diagnostic of diabetes and prediabetes, respectively. Hospital records were reviewed to identify patients with previously diagnosed diabetes.

Results Among 4580 presentations, 2652 had blood sampled of which 1267 samples had HbA1c measured. Of these, 487 (38.4%) had diabetes (either HbA1c≥6.5% or a prior diagnosis), and a further 347 (27.4%) had prediabetes. Among those with diabetes, 32.2% were previously undiagnosed.

Conclusions Routine HbA1c testing in the ED identifies a large number of people with undiagnosed diabetes and prediabetes, and provides an opportunity to improve their care.

  • HbA1c
  • Emergency Room
  • Diagnosis
  • Pre-Diabetes

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjdrc-2015-000191

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