Pilot study of random finger prick glucose testing as a screening tool for type 2 diabetes mellitus in the emergency department

Abstract

Background: A study was undertaken to determine the prevalence of undiagnosed hyperglycaemia among patients in the emergency department (ED) and to evaluate the usefulness of random fingerprick plasma glucose (RFPG) screening in the ED with GP follow-up. Methods: A cross-sectional pilot study of 101 nondiabetic patients in the ED aged >45 years was performed. Results: 31 (30.7%) had never had diabetic screening. 67 (66.3%) had plasma glucose levels >5.5 mmol/l and were advised to consult their GP; 38 (56.7%) did so and 23 (60.5%) of these had follow-up testing. Nine patients (8.9%) were ultimately diagnosed with impaired glucose metabolism. Conclusion: There is considerable potential for diabetic screening in the ED setting.It is estimated that 7.2% of Australians aged .25 years have type 2 diabetes mellitus and that 50% are undiagnosed. [1][2][3][4] We aimed to determine the prevalence of undiagnosed hyperglycaemia among patients in the emergency department (ED) and to evaluate the usefulness of random fingerprick plasma glucose (RFPG) screening in the ED with GP follow-up. METHODSA prospective cross-sectional pilot study was performed between June 2006 and March 2007 in a tertiary referral ED (annual census 55 000). Convenience samples of consecutive patients presenting during 13 separate 4-hour enrolment periods on all 7 days of the week were enrolled. Enrolment periods were dictated by the availability of the principal investigator, were scattered throughout the study period and comprised approximately equal numbers of 08.00-12.00 h, 12.00-16.00 h and 16.00-20.00 h blocks. Patients were excluded if they were aged ,45 years, refused to participate, were diabetic or unable to consent due to illness or communication difficulty.Data were collected using a researcher-administered questionnaire prior to RFPG testing. The primary end points were the proportions of patients who had hyperglycaemia (RFPG >5.5 mmol/l, the Diabetes Australia screening cut-off level), who followed up after an abnormal screening result and who were ultimately found to have abnormal glucose tolerance.The RFPG was measured with a single MediSense Optium machine (Abbott Laboratories, Doncaster, Australia). Patients with RFPG >5.5 mmol/l were advised to consult their GP within 1 month of discharge and were followed up by telephone at 2 months. RESULTSOf 394 consecutive patients who presented during the 13 enrolment periods, 293 were excluded (178 aged ,45 years, 46 diabetic, 61 unable to consent, 8 refused). Of the 101 patients enrolled, 31 (30.7%, 95% confidence interval (CI) 22.1% to 40.8%) had never been screened for diabetes. Sixty-seven patients (66.3%, 95% CI 56.2% to 75.3%) had an RFPG >5.5 mmol/l (range 5.5-12.7 mmol/l). Thirty-eight (56.7%) of these followed up with their GP and 23 (60.5%) had follow-up tests. Nine enrolled patients (8.9%, 95% CI 4.4% to 16.7%) were ultimately diagnosed with impaired glucose metabolism.Patients failed to follow up for a variety of reasons including no memory of the ED visit or GP referral le...

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“…The failure of one‐third of physicians to retest in our study is consistent with previous reports (Hewat et al. , Friedman et al. ).…”

“…Notifying the primary care physician directly has been suggested as an important strategy to improve follow‐up and retesting rates in other settings of opportunistic screening (Hewat et al. , Friedman et al. ).…”

Incidental findings of elevated random plasma glucose in the ED as a prompt for outpatient diabetes screening: a retrospective study

“…A lack of follow-up has consistently been identified as a problem in other studies, often trending towards half of patients not following up 1517 18 The high follow-up rate in our study may be attributable to a more health-conscious Canadian population or may likely be due to a substantial number of reminder telephone calls (minimum of 8) from the study researchers to patients delaying follow-up. Poor follow-up has often been cited as an argument against using the ED for routine screening 15…”

“…In the current study, 7% of FPs did not conduct further testing despite the patient's request. In a pilot study by Hewat et al ,18 the proportion was 50%. This phenomenon may be attributable to the controversial role for RPG in screening for diabetes and this stresses the importance of FP education to ensure an improved collaboration with the ED.…”

“…Poor follow-up has often been cited as an argument against using the ED for routine screening 1517 18 Suggestions for improvement include investigators notifying the FPs directly, ED diabetic teaching and reminders to patients to seek follow-up care.…”