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Screening for type 2 diabetes with random finger‐prick glucose and bedside HbA1c in an Australian emergency department
Author(s) -
Jelinek George A,
Weiland Tracey J,
Moore Gaye,
Tan Grace,
Maslin Marg,
Bowman Kath,
Ward Glenn,
O'Dea Kerin
Publication year - 2010
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/j.1742-6723.2010.01333.x
Subject(s) - medicine , emergency department , referral , diabetes mellitus , type 2 diabetes mellitus , population , type 2 diabetes , confidence interval , tertiary referral hospital , pediatrics , family medicine , retrospective cohort study , endocrinology , environmental health , psychiatry
Objective: To determine if screening for undiagnosed type 2 diabetes mellitus (T2DM) and pre‐diabetes is feasible in an Australian ED; to estimate the prevalence of T2DM and pre‐diabetes in the Australian ED population. Methods: Prospective cross‐sectional prevalence survey in the ED of St Vincent's Hospital, Melbourne, an adult, tertiary referral centre seeing approximately 40 000 patients annually. A convenience sample of adult patients was screened with finger‐prick random blood glucose and glycosylated haemoglobin (HbA1c); those over 6.0 mmol/L and 6.0% were referred for oral glucose tolerance test (OGTT). Diagnoses of T2DM and pre‐diabetes were made according to World Health Organization definitions. Those not attending for OGTT were contacted by phone, and interviewed about their reasons. Results: Seven hundred and twenty‐five patients were recruited; 135 (18.6%; 95% confidence intervals [CI] 15.9–21.6%) had known T2DM, leaving 590 screened, of whom 210 screened positive. Of the 192 referred for OGTT, 147 (77%) did not attend despite several telephone reminders. Of the 45 (23%) completing OGTT, pre‐diabetes was present in eight (17.8%; 95% CI 9.0–31.6%) and T2DM in six (13.3%; 95% CI 5.9–26.6%). Many people interviewed (18/86, 21%) did not attend for OGTT on the advice of their doctors. Conclusions: This inner city tertiary ED has a high prevalence of T2DM, diagnosed and undiagnosed, with as much as half our population possibly affected. Although ED screening might have a high yield, opportunistic screening is not feasible, with difficulties in staff engagement and patient follow up for diagnostic testing. Future studies might consider finger‐prick fasting blood glucose through a patient's general practitioner for diagnosis.