Nontargeted Diabetes Screening in a Navajo Nation Emergency Department

Anderson, Eric G.; Dworkis, Daniel A.; DeFries, Triveni; Emery, Eleanor; Deegala, Chandima; K, Mohs

doi:10.2105/ajph.2018.304799

Cited by 9 publications

(8 citation statements)

References 6 publications

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“…Nevertheless, despite these biases preventing complete generalizability of this study’s findings, several advantages remain. First, despite the reliance on patient histories, the percentage of diabetic and hypertensive patients in this data is in accordance with previous Navajo patient screening studies, suggesting that this study’s comorbidity numbers may be generalizable [ 14 , 15 , 16 ]. In addition, by separating patients that present to the clinic with glasses from those without, using the WHO definitions to classify patients without glasses would likely lead to the inclusion of many patients that require no glasses at all.…”

Section: Discussionsupporting

confidence: 87%

Patterns of Blindness in the Navajo Nation: A 9-Year Study

Wallace

Murri

McCoy

et al. 2022

Vision

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The Navajo Nation is the largest Native American reservation by area and citizenship. The study sought to provide the first large-scale examination of ocular pathology within this population. A retrospective review of all Navajo patients seen at Moran Eye Center Navajo Nation Outreach Clinics from 2013 to 2021 for demographics, visual acuity, refractive, and eye pressure data was undergone. Further variables included comorbidity and eye diagnoses among patients at these clinics. Results: First-time patient visits totaled 2251 from 2013 to 2021. The median age was 53 (range, 18 to 92), and clinics had a predominance of female patients (1387:864). Among patients presenting without glasses, 20.67% (198/958), 9.71% (93/958), and 3.13% (30/958) had mild visual impairment (VI), moderate to severe VI, and blindness, respectively. Cataracts were the most common cause of blindness in these patients (40%, 12/30) and the need for glasses was the second most common cause (33%, 10/30). From 2016 to 2021, 17.71% (48/271) of diabetic patients were diagnosed with diabetic retinopathy (DR). Within the subset of Navajo patients that presented without any correction, 73% of bilateral blindness was preventable via glasses prescription or cataract surgery. This study comments on questions of equitable care for Navajo patients.

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Section: Discussionsupporting

confidence: 87%

Patterns of Blindness in the Navajo Nation: A 9-Year Study

Wallace

Murri

McCoy

et al. 2022

Vision

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“…At the Northern Navajo Medical Center, a rural Indian Health Service emergency department in Shiprock, New Mexico, providers screened people presenting to the emergency department. Of 924 people tested for T2DM, 26.2% ( n = 242 participants) had undiagnosed prediabetes and 2.6% ( n = 24 participants) had undiagnosed T2DM 51 . Similarly, diabetes screening and education at a local festival (Pioneer Day) in Loachapoka, Alabama, allowed for the increased detection of previously undiagnosed prediabetes and T2DM 52 …”

Section: Resultsmentioning

confidence: 99%

Burden and management of type 2 diabetes in rural United States

Dugani

Mielke

Vella

2020

Diabetes Metabolism Res

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In the United States, rural areas have a higher burden of type 2 diabetes (T2DM) compared to urban areas. However, there is limited information on risk factors and interventions that improve the primary prevention and management of T2DM in rural areas. To synthesize current knowledge on T2DM in rural areas and to guide healthcare providers and policy makers, we reviewed five scientific databases and the grey literature over the last decade (2010–2020). We described classification systems for rurality and the T2DM burden based on rurality and region (West, South, Midwest, and Northeast). We highlighted risk factors for T2DM in rural compared to urban areas, and summarized interventions to screen and manage T2DM based on opportunistic screening, T2DM self‐management, community‐based initiatives, as well as interventions targeting comorbidities and T2DM. Several studies identified the co‐existence of T2DM and depression/psychological symptoms, which could reduce adherence to non‐pharmacologic and pharmacologic management of T2DM. We highlighted the role of technology in education and counselling of patients with geographic and financial barriers to accessing care, which is exacerbated by the SARS‐CoV‐2 coronavirus disease‐19 pandemic. We identified knowledge gaps and next steps in improving T2DM care in rural areas. There is an urgent need for interventions tailored to rural areas given that rural Americans currently experience a disproportionate burden of T2DM and are encumbered by its associated morbidity, mortality, and loss in economic productivity.

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“…From these 570 papers, 21 relevant records were followed up after duplicate papers, conference abstracts and letters were excluded. [5][6][7]9,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Full text was available for 18 papers with abstracts for three entries. The relevant, research papers were from Europe (9, including 4 from the UK), Australia (5), America (5), Canada (1) and East Africa (1).…”

Section: Results Of Literature Searchesmentioning

confidence: 99%

use of HbA1c for new diagnosis of diabetes in those with hyperglycaemia on admission to or attendance at hospital urgently requires research

et al. 2022

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The prevalence of diabetes in Birmingham is 11% but it is 22% in hospital inpatients. Queen Elizabeth Hospital in Birmingham (QEHB) serves a multi-ethnic population with 6% Afro-Caribbean, 19% South Asian and 70% White European. A clinical audit of 18,965 emergency admissions to QEHB showed that 5% were undiagnosed but had admission glucose in the ‘diabetes’ range and 16% were in the ‘at risk’ range. The proportion of Afro-Caribbeans (7%) and South Asians (8%) in the ‘diabetes’ range was higher than White Europeans (5%). Given the magnitude of the problem, this paper explores the issues concerning the use of reﬂex HbA1c testing in the UK for diagnosis of diabetes in hospital admissions. HbA1c testing is suitable for most patients but conditions affecting red blood cell turnover invalidate the results in a small number of people. However, there are pertinent questions relating to the introduction of such testing in the NHS on a routine basis. Literature searches on a topical question ‘Is hyperglycaemia identiﬁed during emergency admission/attendance acted upon?’, were performed from 2016 to 2021 and 2016 to 2022. They identiﬁed 21 different, relevant, research papers - 5 from Australia, 9 from Europe including 4 from the UK, 5 from America and 1 each from Canada and Africa. These papers revealed an absence of established procedures for the management and follow-up of routinely detected hyperglycaemia using HbA1c when no previous diabetes diagnosis was recorded. Further work is required to determine the role of reﬂex HbA1c testing for diagnosis of diabetes in admissions with hyperglycaemia, and the cost-effectiveness and role of point-of-care HbA1c testing.

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Nontargeted Diabetes Screening in a Navajo Nation Emergency Department

Cited by 9 publications

References 6 publications

Patterns of Blindness in the Navajo Nation: A 9-Year Study

Patterns of Blindness in the Navajo Nation: A 9-Year Study

Burden and management of type 2 diabetes in rural United States

use of HbA1c for new diagnosis of diabetes in those with hyperglycaemia on admission to or attendance at hospital urgently requires research

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