Identification of Previously Undiagnosed Diabetes and Prediabetes in the Inpatient Setting Using Risk Factor and Hemoglobin A1C Screening

Ochoa, Pamella; Terrell, Brian T.; Vega, J.A.; Mnjoyan, Sofia Z.; Lu, Celia; Klein, Mary S.; Binkley, Gary W.

doi:10.1177/1060028014547383

Cited by 9 publications

(10 citation statements)

References 13 publications

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“…In an earlier report of emergency department patients from the same institution, the frequency of undiagnosed diabetes was 10.5%, similar to the 9% observation unit frequency in this report . We were unable to find similar observation unit studies, although our results are similar to newly diagnosed dysglycemia reports from emergency department (range 42–66%) and inpatient settings (range 30–48%) .…”

Section: Resultssupporting

confidence: 69%

“…Furthermore, the haemoglobin A 1c (HbA 1c ) test has allowed diabetes screening to become more easily conducted in the hospital, as its values are not influenced by recent illness or exercise, and patients do not need to fast prior to their blood test . A number of studies have determined the prevalence of undiagnosed dysglycemia in various settings, including inpatient populations and emergency department populations . However, little data exist on patients admitted to an observation unit from the emergency department.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of undiagnosed dysglycemia in an emergency department observation unit

Silverman

Schleicher

Valente

et al. 2015

Diabetes Metabolism Res

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Section: Resultssupporting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Prevalence of undiagnosed dysglycemia in an emergency department observation unit

Silverman

Schleicher

Valente

et al. 2015

Diabetes Metabolism Res

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“…[CVD]) (8,9) may help differentiate people with previously undiagnosed diabetes and dysglycemia from those with stress-induced hyperglycemia and provides an opportunity to diagnose and initiate diabetes therapies (10)(11)(12)(13). Among people admitted to an intensive care unit (ICU), an A1C drawn at admission allows identification of people with previously unknown diabetes, people at risk of glycemic management challenges and people at an increased risk of mortality (14,15).…”

Section: Introductionmentioning

confidence: 99%

In-Hospital Management of Diabetes

Malcolm¹,

Halperin²,

Miller³

et al. 2018

Canadian Journal of Diabetes

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is common in hospitalized people, even among those without a previous history of diabetes, and is associated with increased in-hospital complications, longer length of stay and mortality. • Insulin is the most appropriate pharmacologic agent for effectively controlling glycemia in hospital. A proactive approach to glycemic management using scheduled basal, bolus and correction (supplemental) insulin is the preferred method. The use of correction-only (supplemental) insulin, which treats hyperglycemia only after it has occurred, should be discouraged as the sole modality for treating elevated blood glucose levels. • For the majority of noncritically ill hospitalized people with diabetes, preprandial blood glucose targets should be 5.0 to 8.0 mmol/L, in conjunction with random blood glucose values <10.0 mmol/L, as long as these targets can be safely achieved. For critically ill hospitalized people with diabetes, blood glucose levels should be maintained between 6.0 and 10.0 mmol/L. • Hypoglycemia is a major barrier to achieving targeted glycemic control in the hospital setting. Health-care institutions should develop protocols for the assessment and treatment of hypoglycemia. KEY MESSAGES FOR PEOPLE WITH DIABETES • If your admission to hospital is planned, talk with your health-care providers (e.g. surgeon, anesthetist, primary care provider, diabetes health provider, etc.) before you are admitted in order to develop an in-hospital diabetes care plan that addresses such issues as: • Who will manage your diabetes in the hospital? • Will you be able to self-manage your diabetes? • What adjustments to your diabetes medications or insulin doses may be necessary before and after medical procedures or surgery? • If you use an insulin pump, are hospital staff familiar with pump therapy? • Your blood glucose levels may be higher in hospital than your usual target range due to a variety of factors, including the stress of your illness, medications, medical procedures and infections. • Your diabetes medications may need to be changed during your hospital stay to manage the changes in blood glucose, or if medical conditions develop that make some medications no longer safe to use. • When you are discharged, make sure that you have written instructions about: • Changes in your dosage of medications or insulin injections or any new medications or treatments • How often to check your blood glucose • Who to contact if you have difficulty managing your blood glucose levels. Screening for and Diagnosis of Diabetes and Hyperglycemia in the Hospital Setting A history of diabetes should be elicited in all patients admitted to hospital and, if present, should be clearly identified on the medical record. In view of the high prevalence of inpatient hyperglycemia with associated poor outcomes, an admission BG measurement of all patients would help identify people with diabetes, even in the absence of a prior diagnosis (1,5). In-hospital hyperglycemia is defined as any glucose value >7.8 mmol/L. For hospitalized people with known diabetes,...

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“…Undiagnosed diabetes represents almost one-third of all diabetes cases in the general population of the United States, impacting approximately 8.1 million individuals [9] . Estimates of undiagnosed diabetes among hospitalized patients vary widely, but are higher than 20% in some settings [10] , [11] , [12] , [13] .…”

Section: Introductionmentioning

confidence: 99%

The burden of diagnosed and undiagnosed diabetes in Native Hawaiian and Asian American hospitalized patients

Sentell

Cheng

Saito

et al. 2015

Journal of Clinical & Translational Endocrinology

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Highlights38% of Native Hawaiian, 34% of Japanese, 33% of Filipino, 23% of Chinese and 19% of White inpatients had diagnosed diabetes.3% Native Hawaiian, 3% Japanese, 4% Filipino, 4% Chinese and 4% White inpatients had potentially undiagnosed diabetes.Few potentially undiagnosed diabetes cases were found. Prospective methods are recommended.Potentially undiagnosed diabetes was associated with a longer hospital stay and higher mortality.Inpatient diabetes screening with HbA1c is suggested, which should be evaluated prospectively for improved outcomes.

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Identification of Previously Undiagnosed Diabetes and Prediabetes in the Inpatient Setting Using Risk Factor and Hemoglobin A1C Screening

Cited by 9 publications

References 13 publications

Prevalence of undiagnosed dysglycemia in an emergency department observation unit

Prevalence of undiagnosed dysglycemia in an emergency department observation unit

In-Hospital Management of Diabetes

The burden of diagnosed and undiagnosed diabetes in Native Hawaiian and Asian American hospitalized patients

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