title: Preoperative "NPO" as an opportunity for diabetes screening.
abstract: BACKGROUND
  Novel preventive care opportunities, such as in hospitalized patients, may merit further investigation in an Accountable Care Organization (ACO) model. As 40% of patients with diabetes are undiagnosed, diabetes screening is an urgent public health need. Screening fasting preoperative patients may present an effective means to identify patients who might otherwise remain undiagnosed.
  
  
  OBJECTIVE
  To pilot an inpatient preventive care strategy for diabetes screening that would ascertain prevalence of unrecognized inpatient diabetes (DM) and impaired fasting glucose (IFG), determine reproducibility of preoperative fasting blood glucose (FBG), and establish feasibility of inpatient preventive screening.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Large Midwestern academic medical center.
  
  
  METHODS
  Two hundred seventy-five elective orthopedic patients with a preoperative visit between December 1, 2007 and November 30, 2008. Most patients (96.6%) had seen their primary care provider (PCP) within 12 months, and 100% were insured.
  
  
  METHODS
  Medical history was recorded, and hemoglobin A(1C) (Hgb A(1C) ) and FBG were drawn immediately prior to surgery. Patients with preoperative FBG ≥100 mg/dL had FBG drawn 6-8 weeks postoperatively.
  
  
  RESULTS
  Twenty-four percent (67/275) of patients had previously unrecognized DM or IFG by virtue of 2 abnormal values. Sixty-four percent of patients with FBG ≥100 mg/dL preoperatively remained elevated at ambulatory follow-up. No patients with new DM or IFG had point-of-care glucose checks ordered or had dysglycemia mentioned on discharge summary.
  
  
  CONCLUSIONS
  Inpatient undiagnosed DM and IFG is common, even in insured, elective surgery patients with recent primary care visits. Preoperative FBG can be used to screen, but results need to be conveyed to PCPs.
authors.affiliation: Department of Medicine, Division of Hospital Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705, USA. asr@medicine.wisc.edu
authors.forename: Ann M
authors.initials: AM
authors.lastname: Sheehy
authors.forename: Joan
authors.initials: J
authors.lastname: Benca
authors.forename: Simone L
authors.initials: SL
authors.lastname: Glinberg
authors.forename: Zhanhai
authors.initials: Z
authors.lastname: Li
authors.forename: Amit
authors.initials: A
authors.lastname: Nautiyal
authors.forename: Paul A
authors.initials: PA
authors.lastname: Anderson
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Squire
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Coursin
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000473:pathology; D005215:Fasting; D005240:Feasibility Studies; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000473:pathology; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011315:Preventive Medicine / Q000379:methods*; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin