Introduction Nearly half of patients tested in emergency departments in Western Sydney have some form of glucose dysregulation, accelerating their risk of cardiovascular disease. We evaluated the prevalence and management of type 2 diabetes (T2D) in patients admitted under the cardiology team in Blacktown Hospital, and the uptake of newer cardioprotective diabetes therapies.
Method Patients presenting to Blacktown and Mount Druitt ED who were admitted under the cardiology service during a 1-month period were screened for T2D with a serum HbA1c measurement. Electronic medical records were audited for clinical information and outcomes. Patients were classified as having newly diagnosed diabetes, pre-diabetes, obesity or overweight using established definitions.
Results A total of 233 patients were included with a mean age of 64±16 yrs, and 60% were male, 27% overweight and 35% obese. Known T2D comprised 36% (n=84) of the cohort, whereas 6% (n=15) had a new diagnosis of T2D. None of the incident cases were referred for inpatient or outpatient diabetes review. A minority (2%, n=5) had known pre-diabetes while 29% (n=68) had a new diagnosis. Of patients with a history of diabetes, 27% (n=23) and 7% (n=6) suffered hyper- and hypoglycaemia, 51% (n=43) had sub-optimally controlled T2D (i.e. HbA1c >7.0%) and over half (56%, n=47) had coronary artery disease. Only 1 patient was treated with an SGLT-2 inhibitor and no patients were on GLP-1 analogues. The majority (62%, n=29) were managed with metformin, sulfonylurea and/or insulin.
Conclusion Undiagnosed T2D and pre-diabetes is highly prevalent in patients being admitted to the cardiology service, and their diabetes is a neglected issue. The high detection rate of pre-diabetes represents a potential opportunity for intervention. Few patients with comorbid T2D and coronary artery disease were managed with therapies of proven cardiac and mortality benefit.