title: Increased A1C among adult emergency department patients with type 2 diabetes.
abstract: OBJECTIVE
  Long-term glycemic control can prevent or delay complications of diabetes. Although diabetes is a common comorbidity in emergency department (ED) patients, the adequacy of long-term control is not known. Our objectives are to determine the frequency of poorly controlled type 2 diabetes among adults presenting to an ED and to identify characteristics associated with poor control.
  
  
  METHODS
  An A1C level was obtained for diabetic patients 18 years and older who presented to the ED for acute medical problems and had blood tests performed for usual medical care. Consecutive patients were screened for a total of 58 24-hour periods during a 10-week period. A1C values were stratified, with less than 7% defined as good control and greater than or equal to 7% poor long-term control. Logistic regression analysis was used to identify factors associated with poor control.
  
  
  RESULTS
  Of the 500 patients with type 2 diabetes, 53.4% had inadequate long-term control. An increased ED glucose level was independently associated with an increased A1C level. If the ED glucose level was 126 to 149 mg/dL, the odds ratio (OR) for an increased A1C level relative to a glucose level less than 100 mg/dL was 2.3 (95% confidence interval [CI] 0.95, 5.68); the OR was 6.4 (95% CI 2.9, 14.1) for glucose levels 150 to 199 mg/dL, and for glucose level of 200 mg/dL or above, the OR for an increased A1C level was 21.2 (9.1, 49.3). Other factors independently associated with increased A1C level were black race, aged 40 to 59 years, and Medicaid insurance.
  
  
  CONCLUSIONS
  The high frequency of A1C levels more than 7% points to the ED as a potential source for identifying patients with poorly controlled type 2 diabetes.
authors.affiliation: Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA. rsilverm@lij.edu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Silverman
authors.forename: Harman
authors.initials: H
authors.lastname: Arora
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kwiatkowski
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Graff
authors.forename: Emily
authors.initials: E
authors.lastname: Baneman
authors.forename: Nina
authors.initials: N
authors.lastname: Kohn
authors.forename: Cynthia
authors.initials: C
authors.lastname: Foss Bowman
authors.forename: Kelly N
authors.initials: KN
authors.lastname: Smith
authors.forename: Martin L
authors.initials: ML
authors.lastname: Lesser
mesh_terms: D000328:Adult; D000367:Age Factors; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D044469:Racial Groups / Q000706:statistics & numerical data
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin