title: Using Automated HbA1c Testing to Detect Diabetes Mellitus in Orthopedic Inpatients and Its Effect on Outcomes.
abstract: OBJECTIVE
  The prevalence of diabetes is rising, and people with diabetes have higher rates of musculoskeletal-related comorbidities. HbA1c testing is a superior option for diabetes diagnosis in the inpatient setting. This study aimed to (i) demonstrate the feasibility of routine HbA1c testing to detect the presence of diabetes mellitus, (ii) to determine the prevalence of diabetes in orthopedic inpatients and (iii) to assess the association between diabetes and hospital outcomes and post-operative complications in orthopedic inpatients.
  
  
  METHODS
  All patients aged ≥54 years admitted to Austin Health between July 2013 and January 2014 had routine automated HbA1c measurements using automated clinical information systems (CERNER). Patients with HbA1c ≥6.5% were diagnosed with diabetes. Baseline demographic and clinical data were obtained from hospital records.
  
  
  RESULTS
  Of the 416 orthopedic inpatients included in this study, 22% (n = 93) were known to have diabetes, 4% (n = 15) had previously unrecognized diabetes and 74% (n = 308) did not have diabetes. Patients with diabetes had significantly higher Charlson comorbidity scores compared to patients without diabetes (median, IQR; 1 [0,2] vs 0 [0,0], p<0.001). After adjusting for age, gender, comorbidity score and estimated glomerular filtration rate, no significant differences in the length of stay (IRR = 0.92; 95%CI: 0.79-1.07; p = 0.280), rates of intensive care unit admission (OR = 1.04; 95%CI: 0.42-2.60, p = 0.934), 6-month mortality (OR = 0.52; 95%CI: 0.17-1.60, p = 0.252), 6-month hospital readmission (OR = 0.93; 95%CI: 0.46-1.87; p = 0.828) or any post-operative complications (OR = 0.98; 95%CI: 0.53-1.80; p = 0.944) were observed between patients with and without diabetes.
  
  
  CONCLUSIONS
  Routine HbA1c measurement using CERNER allows for rapid identification of inpatients admitted with diabetes. More than one in four patients admitted to a tertiary hospital orthopedic ward have diabetes. No statistically significant differences in the rates of hospital outcomes and post-operative complications were identified between patients with and without diabetes.
authors.affiliation: University of Melbourne, Department of Medicine, Austin Health, Melbourne, Australia.|Department of Endocrinology, Austin Health, Melbourne, Australia.|Menzies School of Health Research, Darwin, Australia.
authors.forename: Elif I
authors.initials: EI
authors.lastname: Ekinci
authors.affiliation: University of Melbourne, Department of Medicine, Austin Health, Melbourne, Australia.
authors.forename: Alvin
authors.initials: A
authors.lastname: Kong
authors.affiliation: The Florey Institute of Neuroscience & Mental Health, Melbourne, Australia.
authors.forename: Leonid
authors.initials: L
authors.lastname: Churilov
authors.affiliation: Department of Endocrinology, Austin Health, Melbourne, Australia.
authors.forename: Natalie
authors.initials: N
authors.lastname: Nanayakkara
authors.affiliation: Department of Endocrinology, Austin Health, Melbourne, Australia.
authors.forename: Wei Ling
authors.initials: WL
authors.lastname: Chiu
authors.affiliation: University of Melbourne, Department of Medicine, Austin Health, Melbourne, Australia.|Department of Endocrinology, Austin Health, Melbourne, Australia.
authors.forename: Priya
authors.initials: P
authors.lastname: Sumithran
authors.affiliation: Department of Endocrinology, Austin Health, Melbourne, Australia.
authors.forename: Frida
authors.initials: F
authors.lastname: Djukiadmodjo
authors.affiliation: Department of Endocrinology, Austin Health, Melbourne, Australia.
authors.forename: Erosha
authors.initials: E
authors.lastname: Premaratne
authors.affiliation: Austin Centre for Applied Clinical Informatics, Austin Health, Melbourne, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Owen-Jones
authors.affiliation: Department of Intensive Care, Austin Health, Melbourne, Australia.
authors.forename: Graeme Kevin
authors.initials: GK
authors.lastname: Hart
authors.affiliation: Austin Centre for Applied Clinical Informatics, Austin Health, Melbourne, Australia.
authors.forename: Raymond
authors.initials: R
authors.lastname: Robbins
authors.affiliation: Department of Orthopaedic Surgery, Austin Health, Melbourne, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hardidge
authors.affiliation: Department of General Medicine, Austin Health, Melbourne, Australia.
authors.forename: Douglas
authors.initials: D
authors.lastname: Johnson
authors.affiliation: Department of Endocrinology, Austin Health, Melbourne, Australia.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Baker
authors.affiliation: University of Melbourne, Department of Medicine, Austin Health, Melbourne, Australia.|Department of Endocrinology, Austin Health, Melbourne, Australia.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Zajac
mesh_terms: D001331:Automation; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D003955:Diagnostic Tests, Routine; D005240:Feasibility Studies; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D011446:Prospective Studies
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human