Glucose testing and insufficient follow-up of abnormal results: a cohort study.
BACKGROUND
More than 6 million Americans have undiagnosed diabetes. Several national organizations endorse screening for diabetes by physicians, but actual practice is poorly understood. Our objectives were to measure the rate, the predictors and the results of glucose testing in primary care, including rates of follow-up for abnormal values.


METHODS
We conducted a retrospective cohort study of 301 randomly selected patients with no known diabetes who received care at a large academic general internal medicine practice in New York City. Using medical records, we collected patients' baseline characteristics in 1999 and followed patients through the end of 2002 for all glucose tests ordered. We used multivariate logistic regression to measure associations between diabetes risk factors and the odds of glucose testing.


RESULTS
Three-fourths of patients (78%) had at least 1 glucose test ordered. Patient age (> or = 45 vs. < 45 years), non-white ethnicity, family history of diabetes and having more primary care visits were each independently associated with having at least 1 glucose test ordered (p < 0.05), whereas hypertension and hyperlipidemia were not. Fewer than half of abnormal glucose values were followed up by the patients' physicians.


CONCLUSIONS
Although screening for diabetes appears to be common and informed by diabetes risk factors, abnormal values are frequently not followed up. Interventions are needed to trigger identification and further evaluation of abnormal glucose tests.
Kern
Lisa M
LM
Department of Public Health, Weill Medical College, Cornell University, New York, NY, USA. lmk2003@med.cornell.edu
Callahan
Mark A
MA
Brillon
David J
DJ
Vargas
Maryelena
M
Mushlin
Alvin I
AI
D000046:Academic Medical Centers; D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D003266:Continuity of Patient Care; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000208:ethnology; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000592:standards*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009519:New York City; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards*; D012189:Retrospective Studies
D001786:Blood Glucose