212748 Random HbA1c as a screening tool for diabetes mellitus (DM) in the emergency department (ED)

Sunday, November 8, 2009

Urvi Thakker, DO , Department of Emergency Medicine Long Island Jewish Medical Center, North Shore - Long Island Jewish Healthcare System, New Hyde Park, NY
Tovah Ellman, MD , Department of Emergency Medicine Long Island Jewish Medical Center, North Shore - Long Island Jewish Healthcare System, New Hyde Park, NY
Reed Magleby, BS , Department of Emergency Medicine Long Island Jewish Medical Center, North Shore - Long Island Jewish Healthcare System, New Hyde Park, NY
Kirsten Graff, BS , Department of Emergency Medicine Long Island Jewish Medical Center, North Shore - Long Island Jewish Healthcare System, New Hyde Park, NY
Andrew Sama, MD , Department of Emergency Medicine Long Island Jewish Medical Center, North Shore - Long Island Jewish Healthcare System, New Hyde Park, NY
James Kelson, PhD , North Shore - Long Island Jewish Healthcare System, Lake Success, NY
Robert Silverman, MD, MS , Department of Emergency Medicine Long Island Jewish Medical Center, North Shore - Long Island Jewish Healthcare System, New Hyde Park, NY
Introduction: The prevalence of diabetes mellitus is rising rapidly although 1/3 of cases remain undiagnosed. The HbA1c was recently recommended as a diagnostic test for diabetes (Diabetes Care, July 2009). Given 120 million annual ED visits in the USA, an ED visit provides further opportunity for identifying undiagnosed diabetics. However, it is not clear whether an ED HbA1c is influenced by stress hyperglycemia of acute illness.

Objective: Determine if an ED HbA1c remains stable over time.

Methods: Adult patients with no known history of DM were tested for HbA1c during their ED and subsequent scheduled follow-up visit within 90 days of the ED visit. The HbA1c differences between the two visits were compared using limits of agreement (LOA) with 95% confidence intervals; predictive values were also calculated using 6.5% to diagnose diabetes.

Results: 525 patients were included (average age 49 years), with 54 out of 525 (10%) having an ED HbA1c ≥ 6.5%. The mean overall ED HbA1c was 5.68% (0.90) and the follow-up HbA1c 5.67% (0.92), (difference -0.0099, LOA -0.753, 0.733). Using the follow-up HbA1c as the criterion gold standard, the PPV of an elevated ED HbA1c was 70% (38/54) and the NPV was 99% (466/471). When elevated ED HbA1c values fell < 6.5% on follow-up, most (13/16) still were in an abnormal range (6.0-6.5%).

Conclusion: An elevated HbA1c in the ED usually remains elevated on follow-up evaluation, suggesting this could be used to screen for diabetes in an acute care setting.

Learning Objectives:
Assess whether a random ED HbA1c is stable enough over time to be used as a screening tool for diabetes mellitus.

Keywords: Diabetes, Screening

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a clinical research fellow with 3 years of clinical experience in the residency program at the North Shore Long Island Jewish Health Care System.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.