Gestational diabetes

High rates of undiagnosed diabetes and prediabetes identified by ED screening

Many people with previously undiagnosed diabetes are being detected by routine screening of blood glucose levels in patients presenting to emergency departments.

ED screening is also identifying alarming rates of pre-diabetes in people under 40 years of age, according to findings presented at the recent Australasian Diabetes Congress (ADC 2019) in Sydney.

Almost 10% of people who had their HbA1c measured in the ED as part of a screening initiative at Westmead Hospital, Sydney, were newly diagnosed with diabetes, researchers from the hospital’s Department of Diabetes and Endocrinology found.

The hospital started routine screening of blood glucose  in the ED in 2017 and HbA1c was automatically measured if BG was ≥10mmol/L. A clinical nurse consultant in diabetes was employed to review patients who were admitted with an elevated HbA1c of ≥9.0% (>57 mmol/mol), and those who were not admitted had the results communicated to their GP.

A total of 685 of 2457 (28%) of ED patients who had HbA1c screened had levels ≥9.0%, of whom 230 (9.4%) were newly diagnosed with diabetes.

The study found that inpatients identified in the HbA1c Screening Initiative and reviewed by the diabetes nurse had shorter lengths of hospital stay compared to the average length of stay for patients with diabetes (4.6 vs 10.6 days).

All patients with diabetes had high rates of readmission (around 12% within a month), presumably due to co-morbidities.

The researchers said the findings showed that routine HbA1c screening of patients in EDs allowed for early identification of undiagnosed diabetes and targeted interventions to reduce hospital length of stay and prevent future risk complications.

In a separate study of HbA1c screening of ED patients under the age of 40 at Sydney’s Blacktown and Mount Druitt Hospital, researchers found that 29.7% (2324) had levels consistent with prediabetes (5.7-6.4% or 39-46 mmol/mol).

The number of people with prediabetes increased linearly with age, and many had other cardiometabolic risk factors such as hypertension (5.5%) and hyperlipidaemia (4.1%), and 25% were smokers.

“Significant cardiovascular risk factors and disease are already present in this young cohort with pre-diabetes – and targeted lifestyle intervention should be promoted, concluded the researchers,” led by of endocrinologist Dr James Cheng Jiang.

The high rates of prediabetes also pointed to a future risk for gestational diabetes for females, they added.

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