Preoperative “NPO” as an opportunity for diabetes screening

Abstract

BACKGROUND:Novel preventive care opportunities, such as in hospitalized patients, may merit further investigation in an Accountable Care Organization (ACO) model. As 40% of patients with diabetes are undiagnosed, diabetes screening is an urgent public health need. Screening fasting preoperative patients may present an effective means to identify patients who might otherwise remain undiagnosed.OBJECTIVE:To pilot an inpatient preventive care strategy for diabetes screening that would ascertain prevalence of unrecognized inpatient diabetes (DM) and impaired fasting glucose (IFG), determine reproducibility of preoperative fasting blood glucose (FBG), and establish feasibility of inpatient preventive screening.DESIGN:Prospective observational study.SETTING:Large Midwestern academic medical center.PATIENTS:Two hundred seventy‐five elective orthopedic patients with a preoperative visit between December 1, 2007 and November 30, 2008. Most patients (96.6%) had seen their primary care provider (PCP) within 12 months, and 100% were insured.MEASUREMENTS:Medical history was recorded, and hemoglobin A1C (Hgb A1C) and FBG were drawn immediately prior to surgery. Patients with preoperative FBG ≥100 mg/dL had FBG drawn 6–8 weeks postoperatively.RESULTS:Twenty‐four percent (67/275) of patients had previously unrecognized DM or IFG by virtue of 2 abnormal values. Sixty‐four percent of patients with FBG ≥100 mg/dL preoperatively remained elevated at ambulatory follow‐up. No patients with new DM or IFG had point‐of‐care glucose checks ordered or had dysglycemia mentioned on discharge summary.CONCLUSIONS:Inpatient undiagnosed DM and IFG is common, even in insured, elective surgery patients with recent primary care visits. Preoperative FBG can be used to screen, but results need to be conveyed to PCPs. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine

Using Automated HbA1c Testing to Detect Diabetes Mellitus in Orthopedic Inpatients and Its Effect on Outcomes

“…In the present study of 416 orthopedic inpatients, our identification of 22% with known diabetes and 4% with previously unrecognized diabetes is similar to the findings of a South Korean study of 173 patients undergoing elective ankle replacement surgery, in whom known and unrecognized diabetes respectively were identified in 22% and 2.9% of patients [27]. In contrast, in another study of 275 hip, knee and spinal surgical patients, it was found that 12% and 3% had known and unrecognized diabetes, respectively [26]. These studies were limited by their smaller sample sizes, and the use of plasma glucose levels or retrospective chart review to classify diabetes status.…”

“…Using a combination of electronic medical records and real-time biochemical measures, we have shown the feasibility of this approach for detection of diabetes in inpatients, representing a window of opportunity to engage with people at high risk whose diabetes may otherwise remain undiagnosed. Furthermore, the automatic inclusion of the diabetes status in the patient’s discharge summary addresses a current deficiency in healthcare transition from the orthopedic wards to the community setting [13, 26]. …”

Prevalence of undiagnosed dysglycemia in an emergency department observation unit

“…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%) .…”

“…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.…”

Detection of Chronic Obstructive Pulmonary Disease in Primary Care in Salzburg, Austria: Findings from the Real World

“…In our survey, participation was higher in females than males, and higher in never than ever smokers, indicating that the efficacy of COPD detection can be increased. Higher participation rates of females have also been reported in other studies conducted in primary-care practices [26,27,28,29,30,31,32]. …”