HbA<sub>1C  </sub>screening in the Emergency Department: Opportunity for better detection, prevention and care.  — ASN Events
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  3. HbA1C  screening in the Emergency Department: Opportunity for better detection, prevention and care. 

HbA1C  screening in the Emergency Department: Opportunity for better detection, prevention and care.  (#335)

Amanda Hor 1 2 , Sumathy Ravi 2 , Tien-Ming Hng 2 3 , Xiaoqi Feng 2 4 , Jaime Lin 2 , Thomas Astell-Burt 2 3 , David Chipps 2 , Mark McLean 2 3 , Glen Maberly 2 3
  1. School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
  2. Western Sydney Local Health District, Blacktown, NSW, Australia
  3. University of Western Sydney, Sydney, NSW, Australia
  4. University of Wollongong, Wollongong, NSW, Australia

Introduction: A pilot study was undertaken measuring HbA1C in patients presenting to the Emergency Department (ED) in an area with a high prevalence of diabetes. Abnormal results were communicated to patients and their General Practitioners (GPs).

Objectives: To reveal the burden of pre-diabetes and diabetes presenting to a hospital ED and to improve integration of care between the hospital and community.

Methods: A 6 week prospective observational study was conducted in individuals presenting to ED at Blacktown Hospital. Blood glucose was measured in all blood samples collected for any clinical indication. HbA1C was automatically measured when the random glucose level was ≥5.5mmol/L. Admitted patients who had HbA1C  of  ≥9% were referred to the inpatient diabetes management team. Notification letters of HbA1C  results ≥6.5% (indicative of diabetes) were sent to the patients and their General Practitioner (GP), followed by an assessment letter to assess the utility of the notification. Patients’ demographic data and previous diabetes diagnosis were obtained from the hospital’s database.

Results: Over 6 weeks there were 4580 presentations to the ED and 1267 (27%) HbA1C tests were performed. Among patients who were tested, diabetes was present in 487 (38%) and pre-diabetes (HbA1C 5.7-6.4%) in another 347 (27%).  32% of patients with diabetes were not previously diagnosed prior to this testing. There were 1901 admissions to the wards from ED, yielding 751 (59%) HbA1C measurements. Of these patients (tested and admitted), 42 % patients had diabetes and 54 (7%) had HbA1C  ≥9%. 40% of patients and 42% of the GP’s returned our assessment letter.

Conclusion: These finding reaffirm the high burden of diabetes in patients presenting to our hospital ED.  Screening of this population is likely to be highly cost effective for case finding and improving the management of patients with diabetes.  Identification of pre-diabetes will enable preventive approaches.  However, reliable communication between the hospital service and GPs will be essential to capitalize on this screening opportunity.