TESTING STRATEGY

Diabetes Screening in ER Improves Detection in High Prevalence Areas

Routine glycated hemoglobin (HbA1c) testing in urban emergency departments identifies a large number of people with undiagnosed diabetes and prediabetes, according to a study published June 3 in BMJ Open Diabetes Research & Care. The authors say that emergency department screening is both feasible and effective in finding previously undiagnosed cases of diabetes and prediabetes in high prevalence areas.

Diabetes has traditionally been diagnosed by fasting blood glucose tests or the oral glucose tolerance test. However, recent adoption of HbA1c simplifies the diagnostic process, by eliminating pre-test preparation, and enables wider screening. It may be key to targeting screening in high-risk populations where diabetes- related complications resulting from underdetection remain a problem.

“Rapidly identifying admitted patients with poor glycemic control utilizing a test on a single blood sample that does not require any pretest preparation provides an ideal opportunity for intervention by hospital diabetes services,” write the authors led by Tien-Ming Hng, M.B.B.S., Ph.D., from Blacktown Hospital in Australia. “The visit to [the] emergency department is an opportunity for us to detect diabetes in individuals who infrequently seek routine medical care, and who may otherwise go undetected.”

Australian researchers conducted random glucose testing in patients requiring blood sampling in an emergency department serving an ethnically diverse, low socioeconomic, urban population, regardless of the presenting problem. HbA1c was automatically measured if the random glucose levels were above 5.5 mmol/L. Consistent with the American Diabetes Association definition HbA1c levels of 6.5 percent or higher were diagnosed for diabetes and levels of 5.7 to 6.4 percent were diagnosed as prediabetes. Hospital records were used to identify patients with previously diagnosed diabetes.

Among 4,580 emergency department cases, 2,652 had blood sampled. HbA1c was in 1,267 of these samples. More than one-third (38.4 percent) had diabetes and an additional 27.4 percent had prediabetes. Among those with diabetes, just under one-third (32.2 percent) were previously undiagnosed and unaware of their condition. Cases of diabetes were not confined to the mild cases. A severely elevated HbA1c level (over 9 percent) was seen in 7.3 percent of the entire cohort, and in 10.2 percent of newly diagnosed patients.

“Almost a third of the individuals diagnosed as having diabetes were not aware of their diagnosis, reflecting the hidden burden of diabetes in our community,” the authors write. “This may indicate that current screening practices in primary care are insufficient and further supports opportunistic HbA1c testing in individuals presenting to hospital.”

As a result of this pilot study, Blacktown and Mount Druitt became the first in Australia to implement routine diabetes screening in emergency department patients requiring a blood test.

Takeaway: Metabolomic profiles in serum may be useful in screening women for early- stage ovarian cancer. While further validation in larger populations is necessary, the researchers say a clinical assay based on the 16 markers is technically feasible.

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