Screening for type 2 diabetes with random finger-prick glucose and bedside HbA1c in an Australian emergency department

Emerg Med Australas. 2010 Oct;22(5):427-34. doi: 10.1111/j.1742-6723.2010.01333.x.

Abstract

Objective: To determine if screening for undiagnosed type 2 diabetes mellitus (T2DM) and pre-diabetes is feasible in an Australian ED; to estimate the prevalence of T2DM and pre-diabetes in the Australian ED population.

Methods: Prospective cross-sectional prevalence survey in the ED of St Vincent's Hospital, Melbourne, an adult, tertiary referral centre seeing approximately 40,000 patients annually. A convenience sample of adult patients was screened with finger-prick random blood glucose and glycosylated haemoglobin (HbA1c); those over 6.0 mmol/L and 6.0% were referred for oral glucose tolerance test (OGTT). Diagnoses of T2DM and pre-diabetes were made according to World Health Organization definitions. Those not attending for OGTT were contacted by phone, and interviewed about their reasons.

Results: Seven hundred and twenty-five patients were recruited; 135 (18.6%; 95% confidence intervals [CI] 15.9-21.6%) had known T2DM, leaving 590 screened, of whom 210 screened positive. Of the 192 referred for OGTT, 147 (77%) did not attend despite several telephone reminders. Of the 45 (23%) completing OGTT, pre-diabetes was present in eight (17.8%; 95% CI 9.0-31.6%) and T2DM in six (13.3%; 95% CI 5.9-26.6%). Many people interviewed (18/86, 21%) did not attend for OGTT on the advice of their doctors.

Conclusions: This inner city tertiary ED has a high prevalence of T2DM, diagnosed and undiagnosed, with over a quarter of our population probably affected [corrected]. Although ED screening might have a high yield, opportunistic screening is not feasible, with difficulties in staff engagement and patient follow up for diagnostic testing. Future studies might consider finger-prick fasting blood glucose through a patient's general practitioner for diagnosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Australia
  • Blood Glucose / analysis*
  • Confidence Intervals
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / diagnosis*
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Glucose Tolerance Test / instrumentation
  • Glucose Tolerance Test / methods*
  • Glycated Hemoglobin A / analysis*
  • Health Care Surveys
  • Humans
  • Male
  • Mass Screening / statistics & numerical data*
  • Middle Aged
  • Point-of-Care Systems
  • Prevalence
  • Prospective Studies
  • Statistics, Nonparametric
  • Triage
  • Young Adult

Substances

  • Blood Glucose
  • Glycated Hemoglobin A