Diabetes is endemic in our Local Health District (LHD). In high risk individuals, glycosylated haemoglobin (HbA1c) measurements can be used to assess for diabetes. We demonstrate the utility of routine HbA1c testing in the Emergency Department (ED).
To report on the outcome of HbA1c testing undertaken in the Emergency Department.
HbA1c assessment is part of routine practice in the ED of Blacktown/Mt Druitt Hospital. Irrespective of the presenting illness, HbA1c is measured in all non-pregnant individuals aged ≥ 18 years if it has not been measured in the preceding 3 months. American Diabetes Association criteria was used to define the categories of diabetes (HbA1c ≥ 6.5%) and pre-diabetes (5.7-6.4%). Demographic data was obtained from the medical record and the Clinical Analytics department.
23,923 individuals were tested over 9 months from June 2016. 28% (n=6722) and 17% (n=3982) had results consistent with pre-diabetes and diabetes respectively. The female to male ratio was 58%:42%. The mean age of males was 60±20 years and females 64±16 years. Subset analysis of the first 14,023 presentations indicate that 56% (n=7869) were admitted. The proportion of prediabetes and diabetes was similar in the non-admitted and admitted cohorts (prediabetes 29.7% vs 30.7%, diabetes 19.2% vs 19.7%). In the admitted cohort, mean (±SEM) HbA1c was 5.96±0.22% (prediabetes) and 7.99±1.62% (diabetes). 323 patients (21% of the diabetes cohort) had HbA1c levels ≥9% with mean of 10.60±1.49%. The mean cost and length of stay (LOS) for admitted patients increases with worsening glycaemia (normal $4541 LOS 83hours, prediabetes $5445 LOS 106hours, diabetes $7358 LOS 123hours).
HbA1c assessment in the ED provides an opportunity to identify individuals with prediabetes and diabetes. A fifth of the inpatient population have results consistent with diabetes and another third with prediabetes. This has health economic implications for the LHD.