title: Prevalence of undiagnosed and suboptimally controlled diabetes by point-of-care HbA1C in unselected emergency department patients.
abstract: OBJECTIVE
  The objective was to estimate the glycemic control of patients with known diabetes and to assess the prevalence of undiagnosed diabetes in an unselected emergency department (ED) population. Secondary objectives include evaluating the prevalence of undiagnosed diabetes in high-risk groups of ED patients such as Hispanic patients, African Americans, and patients with body mass index (BMI) ≥ 30 kg/m(2) .
  
  
  METHODS
  A convenience sample of adult ED patients was screened for diabetes using a National Glycohemoglobin Standardization Program-certified point-of-care (POC) glycated hemoglobin (HbA1C) meter at a single academic medical center during eight 24-hour periods. Diabetes was defined as HbA1C ≥ 6.5%, consistent with new American Diabetes Association (ADA) guidelines.
  
  
  RESULTS
  Of the 1,611 patients evaluated in the ED during the study period, 313 were included in the study sample. Of these, 15% reported a history of diabetes, 42% of whom were suboptimally controlled. An additional 14% of the study sample was found to have previously undiagnosed diabetes. In our limited sample, the prevalence of previously undiagnosed diabetes in Hispanics, African Americans, and patients with BMI ≥ 30 kg/m(2) was 14, 27, and 22%, respectively.
  
  
  CONCLUSIONS
  Patients in our sample had a high prevalence of suboptimally controlled and undiagnosed diabetes. New POC HbA1C devices and simplified diagnostic criteria for diabetes significantly enhance the possibility of ED-based screening programs. Future research should validate our findings in a broader array of EDs and study the acceptance of such ED-based diabetes screening programs.
authors.affiliation: Department of Emergency Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA. menchine@usc.edu
authors.forename: Michael D
authors.initials: MD
authors.lastname: Menchine
authors.forename: Sanjay
authors.initials: S
authors.lastname: Arora
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.forename: Adit A
authors.initials: AA
authors.lastname: Ginde
mesh_terms: D001741:Black or African American; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology; D004636:Emergency Service, Hospital; D005260:Female; D006442:Glycated Hemoglobin; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D019095:Point-of-Care Systems; D015995:Prevalence
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin