Diabetes case finding in the emergency department, using HbA1c: an opportunity to improve diabetes detection, prevention, and care.
OBJECTIVE
We assessed the efficacy of routine glycated hemoglobin (HbA1c) testing to detect undiagnosed diabetes and prediabetes in an urban Australian public hospital emergency department (ED) located in an area of high diabetes prevalence.


METHODS
Over 6 weeks, all patients undergoing blood sampling in the ED had their random blood glucose measured. If ≥5.5 mmol/L (99 mg/dL), HbA1c was measured on the same sample. HbA1c levels ≥6.5% (48 mmol/mol) and 5.7-6.4% (39-46 mmol/mol) were diagnostic of diabetes and prediabetes, respectively. Hospital records were reviewed to identify patients with previously diagnosed diabetes.


RESULTS
Among 4580 presentations, 2652 had blood sampled of which 1267 samples had HbA1c measured. Of these, 487 (38.4%) had diabetes (either HbA1c≥6.5% or a prior diagnosis), and a further 347 (27.4%) had prediabetes. Among those with diabetes, 32.2% were previously undiagnosed.


CONCLUSIONS
Routine HbA1c testing in the ED identifies a large number of people with undiagnosed diabetes and prediabetes, and provides an opportunity to improve their care.
Western Sydney Local Health District, Blacktown Hospital, Blacktown, New South Wales, Australia; School of Medicine, Western Sydney University, Parramatta, New South Wales, Australia.
Tien-Ming
TM
Hng
Western Sydney Local Health District, Blacktown Hospital, Blacktown, New South Wales, Australia; School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia.
Amanda
A
Hor
Western Sydney Local Health District, Blacktown Hospital , Blacktown, New South Wales , Australia.
Sumathy
S
Ravi
Western Sydney Local Health District, Blacktown Hospital, Blacktown, New South Wales, Australia; School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia; Early Start Research Institute, University of Wollongong, Wollongong, New South Wales, Australia.
Xiaoqi
X
Feng
Western Sydney Local Health District, Blacktown Hospital , Blacktown, New South Wales , Australia.
Jaime
J
Lin
School of Science and Health, Western Sydney University, Parramatta, New South Wales, Australia; School of Geography and Geosciences, University of St Andrews, St Andrews, UK.
Thomas
T
Astell-Burt
Western Sydney Local Health District, Blacktown Hospital , Blacktown, New South Wales , Australia.
David
D
Chipps
Western Sydney Local Health District, Blacktown Hospital, Blacktown, New South Wales, Australia; School of Medicine, Western Sydney University, Parramatta, New South Wales, Australia.
Mark
M
McLean
Western Sydney Local Health District, Blacktown Hospital, Blacktown, New South Wales, Australia; School of Medicine, Western Sydney University, Parramatta, New South Wales, Australia.
Glen
G
Maberly
Diagnosis; Emergency Room; HbA1c; Pre-Diabetes