Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Diabetes screening in a Hospital-In-The-Home (HITH) population (#271)

Florence Gunawan 1 , Lyn-Li Lim 2 , Uma Parameswaran 2 , Nick Hewitt 2 , Nerisa Imeri 3 , Shok Yin Lee 3 , Mary O'Reilly 2 4 , Chris Gilfillan 3 4 , Bridget Barber 2 5 , Aaron Kay Hau Choy 1
  1. Barwon Health, Geelong, VIC, Australia
  2. Hospital In The Home, Eastern Health, Box Hill, Victoria, Australia
  3. Eastern Health, Box Hill, Victoria, Australia
  4. Monash University, Melbourne, Victoria, Australia
  5. Menzies School of Health Research, Darwin, Northern Territory, Australia

 

Aims: The prevalence of type 2 diabetes mellitus (T2DM) is high among hospitalised patients1,2, and may be particularly high among those with infections, such as cellulitis3. We assessed the prevalence and associated risk factors of unrecognised diabetes in patients admitted to a HITH program.

 

Methods: Patients admitted to HITH without known T2DM were enrolled. Demographic and clinical details were recorded. Risk of developing T2DM within the next 5 years was calculated using the Australian T2DM risk assessment tool (AUSDRISK), with low, intermediate and high risk defined by scores of <5, 6 – 11, and >12 respectively. Glycated haemoglobin (HbA1c) was used for pre-diabetes (HbA1c 5.7 – 6.4%) and diabetes (HbA1c > 6.5%) screening.

 

Results:

Of 93 patients admitted to HITH during April-July 2016, 70 (75%) did not have known diabetes. Sixty-five (93%) of these patients had a HbA1c performed and were included in analyses. Of these, 16 (25%) had evidence of dysglycaemia; 14/65 (22%) with pre-diabetes and 2/65 (3%) with diabetes, with mean HbA1c of 5.9% and 6.9% respectively. Of those with AUSDRISK calculated, most (n=46/58, 79%) were at high risk of developing T2DM, with fewer at intermediate (n= 7/58, 12%) or low (n= 5/58, 9%) risk. In patients with high, intermediate and low AUSDRISK categories, diabetes or pre-diabetes was diagnosed in 14/46 (30%), 0/7 (0%), and 0/5 (0%) respectively. In patients with cellulitis, 5/16 (31%) had pre-diabetes or diabetes, compared to 11/49 (22%) patients with other diagnoses. Cellulitis was the presenting complaint of the two patients with newly diagnosed diabetes.

 

Conclusions:

The prevalence of unrecognised diabetes is high in this population, with a quarter of the patients diagnosed with pre-diabetes or diabetes. AUSDRISK was a useful tool to determine risk, with pre-diabetes or diabetes diagnosed only in those within the high AUSDRISK category.

 

 

  1. Bach LA, Ekinci EI, Engler D, Gilfillan C et al. The high burden on inpatient diabetes mellitus: the Melbourne public hospitals diabetes inpatient audit. Med J Aust 2014;201 (6):334-338.
  2. Nanayakkara N, Nguyen H, Churilov L, et al. Inpatient HbA1c testing: a prospective observational study. BMJ Open Diab Res Care 2015;3:e000113 doi:10.1136/bmjdrc-2015-000113
  3. Harris RA, Hardman DT, Brown AR. Cellulitis and the occult diabetic. Aust N Z J Surg. 1996 Mar;66(3):175-7.