title: Implementation of a screening program to detect previously undiagnosed dysglycemia in hospitalized patients.
abstract: OBJECTIVE
  Many people with dysglycemia are unaware that they have the condition. We conducted a study to determine whether a screening program for hospitalized patients could identify new cases of unrecognized dysglycemia and affect the actions of attending care providers during hospitalization.
  
  
  METHODS
  We measured A1C in 466 participants with no history of diabetes who had been admitted to hospital for coronary heart disease or elective joint replacement surgery. Participants with A1C <6.0% were considered normoglycemic and those with A1C ≥6.0% were considered dysglycemic. Notifications to care providers were placed on the charts of participants who had dysglycemia, along with recommendations for in-hospital monitoring and care. Oral glucose tolerance tests were completed 6 weeks post-hospitalization for participants with dysglycemia and a subsample of participants who were normoglycemic. Sensitivity and specificity of in-hospital dysglycemia criteria were calculated. Provider practices were determined by chart review.
  
  
  RESULTS
  In-hospital dysglycemia was present in 10.4% of patients with coronary heart disease and 11.4% of participants with elective joint replacement surgery. Attending care providers took few of the recommended actions, despite the chart notification of dysglycemia; glucose monitoring occurred <30% of the time. The in-hospital dysglycemia criterion of ≥6% demonstrated moderate sensitivity (47.5%) and high specificity (96.2%) in detecting dysglycemia based on oral glucose tolerance tests.
  
  
  CONCLUSIONS
  Dysglycemia was a relatively common finding in patients with no history of diabetes who had been admitted for coronary heart disease or elective joint replacement surgery. The in-hospital A1C screening criteria generated a high level of false-negative tests, and a chart notification had limited effects on the practices of attending care providers. Future studies examining lower A1C thresholds and the barriers to and facilitators of attending care providers' behaviours are warranted.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: jamalcolm@ottawahospital.on.ca.
authors.forename: Janine C
authors.initials: JC
authors.lastname: Malcolm
authors.affiliation: Division of Prevention and Rehabilitation, University of Ottawa, Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Jana
authors.initials: J
authors.lastname: Kocourek
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Erin
authors.initials: E
authors.lastname: Keely
authors.affiliation: Division of Orthopedic Surgery, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Feibel
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Brez
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Forster
authors.affiliation: Clinical Services, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Sherrard
authors.affiliation: Division of Prevention and Rehabilitation, University of Ottawa, Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Reid
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement / Q000706:statistics & numerical data; D001786:Blood Glucose / Q000378:metabolism*; D002170:Canada / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000517:prevention & control*; D042241:Early Diagnosis; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008403:Mass Screening / Q000379:methods; D008991:Monitoring, Physiologic / Q000379:methods*; D011236:Prediabetic State / Q000175:diagnosis* / Q000453:epidemiology; D015397:Program Evaluation; D012680:Sensitivity and Specificity
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Ottawa Model for Undiagnosed Dysglycemia (modèle d’Ottawa sur la dysglycémie méconnue); Ottawa Model of Undiagnosed Dysglycemia; diabetes; diabetes screening in-hospital dysglycemia; diabète; dysglycémie en milieu hospitalier; dépistage du diabète; in-hospital glucose control; régulation de la glycémie en milieu hospitalier