undiagnosed diabetes

ED screening program identifies undiagnosed diabetes cases

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An ED screening program identified patients with undiagnosed prediabetes and type 2 diabetes or undermanaged disease, particularly among racial and ethnic minorities and patients with low income, researchers reported in JAMA Network Open.

“Regarding type 2 diabetes, a few studies have conducted short-term screening of all ED patients,” Kirstie K. Danielson, PhD, associate professor of endocrinology, diabetes and metabolism in the department of medicine at the University of Illinois, Chicago, and colleagues wrote. “To our knowledge, ED screening for type 2 diabetes in underserved populations that built into daily clinical care and uses clinical recommendations has not been developed.”

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ED screening can help identify people with undiagnosed prediabetes or type 2 diabetes.

Researchers conducted this pilot program in an ED in Chicago from February to April 2021. Using a best practice alert built into the electronic medical record, researchers identified patients for diabetes screening based on American Diabetes Association criteria: all adults aged 45 years or older, and those aged 18 to 44 years who had a BMI of 25 kg/m2 and no prior diabetes diagnosis and no HbA1c record for the past 3 years. Of 8,441 total patients who visited the ED, 1,085 were flagged as at risk for type 2 diabetes. Of these patients, 758 had prediabetes, 265 had diabetes and 62 had severe diabetes.

Researchers were able to follow-up with 352 of these patients for HbA1c information: 264 with prediabetes (mean age, 51.7 years; 56.8% women) and 88 with type 2 diabetes (mean age, 53.8 years; 47.7% women). Overall, 19.6% of patients were Hispanic, 64.8% were non-Hispanic Black, 9.7% were non-Hispanic white and 6% were non-Hispanic of other race.

Median income of all patients’ ZIP codes was at the 44th percentile of U.S. income. In addition, 50% of patients had public insurance and 4% were uninsured. Of note, 25% of patients self-reported that they were diagnosed with prediabetes or type 2 diabetes before the study, but only 58% reported receiving treatment for their disease, according to the researchers.

“The pilot sample reached by telephone was likely biased toward higher socioeconomic status, indicating those not reached are more likely underserved,” the researchers wrote. “Next steps involve testing implementation strategies to link these new patients to diabetes education and care.”

HbA1c testing in ED targets undiagnosed diabetes, prediabetes

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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