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The impact of acute illness on HbA 1c determination of undiagnosed diabetes
Author(s) -
Thakker Urvi,
Ellman Tovah,
Magleby Reed,
Graff Kirsten,
Kelson James,
Silverman Robert A.
Publication year - 2012
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.2315
Subject(s) - diabetes mellitus , medicine , intensive care medicine , endocrinology
Objective To improve diabetes screening efforts, the American Diabetes Association now recommends haemoglobin A 1c (HbA 1c ) as a diagnostic test, increasing access to patients found in acute care environments. However, the influence of acute illness and care on HbA 1c levels has not been well studied. To address this, we evaluated for intra‐patient differences in HbA 1c assessed in the emergency department (ED) and after recovery from the acute illness. Methods Adult patients with no known history of diabetes were tested for HbA 1c during an ED and scheduled follow‐up visit. HbA 1c differences between the two visits were compared using limits of agreement with 95% confidence intervals. The frequency of individuals who changed diagnostic categories (using ≥6.5% to classify newly diagnosed diabetes) from ED to follow‐up was determined. Results A total of 589 patients were included with a mean age of 50 years, and 57/589 (9.7%) had an ED HbA 1c ≥ 6.5% with the average follow‐up visit 45 days after the ED visit. The mean ED HbA 1c was 5.67% (±0.86), and the follow‐up HbA 1c was 5.65% (±0.89), (difference −0.0129%, 95% limits of agreement −0.740, 0.714). The ED and follow‐up HbA 1c was highly correlated ( r ² = 0.829). Although on follow‐up almost all patients were classified in the same diagnostic category as in the ED, 17 patients had an HbA 1c ≥ 6.5% in the ED and an HbA 1c < 6.5%. On follow‐up most patients (14/17) still fell in an abnormal range (6.0–6.5%). Conclusion The HbA 1c value is not substantially affected by acute illness and is feasible as a screening assay for diabetes in the acute care setting such as an ED. Copyright © 2012 John Wiley & Sons, Ltd.