Diabetes Detection and Communication among Patients Admitted through the Emergency Department of a Public Hospital

Int J Environ Res Public Health. 2020 Feb 4;17(3):980. doi: 10.3390/ijerph17030980.

Abstract

Early identification/diagnosis of diabetes and frequent monitoring of hyperglycemia reduces hospitalizations and diabetes-related complications. The present study investigated the proportion of older adults coded with diabetes or newly diagnosed during their admissions and assessed discharge summary content for diabetes-related information. The study used electronic data on 4796 individuals aged ≥60 years admitted through the emergency department (ED) of a public hospital from 2017 to 2018 extracted using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM code). The proportion of admitted patients who were diagnosed with diabetes over a one-year period, proportion with glycated hemoglobin A1c (HbA1c) and random blood glucose (RBG) test performed during their stay, length of stay, discharge summary information and the factors associated with elevated HbA1c (>7%/53 mmol/mol) were investigated. In total, 8.6% of ED presentations to the hospital were coded with diabetes, excluding gestational consisting of 879 patients (449 males, 430 females) aged ≥ 60 years (74.6 ± 8.9 years). In total, 98% had type 2 diabetes (n = 863), 53% were Australian-born (n = 467), and the mean body mass index (BMI, 31 ± 7 kg/m2; n = 499, 56.8%), RBG (9.8 ± 5.2 mmol/L; n = 824, 93.7%) and HbA1c (8.0 ± 2.0%; n = 137, 15.6%) and length of stay (6.7 ± 25.4 days) were similar between gender, age, and nationality (p > 0.05). Three coded patients (0.3%) were newly diagnosed during the admission. In total, 86% had elevated HbA1c, but this was recorded in 20% of discharge summaries. Patients who are on a combination therapy (adjusted odds ratio 23%, 95% confidence intervals: 7%/38%), those on SGLT2 Inhibitors (aOR, 14%: 2%/26%) or had a change in medication (aOR, 40%: 22%/59%) had lower odds of having elevated HbA1c during admission. The low diagnosis rate of diabetes and the lack of clinical assessment of HbA1c in older adults admitted through the ED of a South Western Sydney public hospital suggest that many patients with diabetes either remain undiagnosed even during admission and/or are going to the ED with unknown diabetes that is unidentified with current practices. The clinically important HbA1c results were only infrequently communicated with general practitioners (GPs).

Keywords: Discharge summary; Hemoglobin A1c; South Western Sydney Local Health District; blood glucose; emergency department; hospital admission; hyperglycemia; opportunistic testing; public health; type 2 diabetes.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Australia
  • Blood Glucose / analysis
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / diagnosis*
  • Diabetes Mellitus, Type 2 / drug therapy
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Glycated Hemoglobin A / analysis
  • Health Communication
  • Hospitalization / statistics & numerical data
  • Hospitals, Public / statistics & numerical data
  • Humans
  • Male
  • Middle Aged

Substances

  • Blood Glucose
  • Glycated Hemoglobin A