Diabetes Case Finding using HbA1c Testing
Western Sydney LHD conducted a pilot study on patients presenting to the Emergency Department (ED) at Blacktown Hospital to assess the efficacy of HbA1c testing to detect diabetes and pre-diabetes in an area of high diabetes prevalence.
Opportunistic blood glucose levels were measured in all non-pregnant individuals who had blood collected after presenting to the ED for any clinical indication. HbA1c was automatically measured if the random glucose level was ≥ 5.5mmol/L. Diabetes was diagnosed if the HbA1c was ≥ 6.5% and pre-diabetes if HbA1c was between 5.7-6.4%.
There were 4580 presentations to the ED and 1267 (27%) HbA1c measurements were obtained over the 6 week period. In this cohort:
- Diabetes (HbA1c of ≥ 6.5%) was present in 38.4% (n=487)
- Diabetes was newly diagnosed in 32.2% (n=157)
Pre-diabetes (HbA1c of 5.7-6.4%) was diagnosed in 27.4% (n=347)
- Hospital coding analysis revealed 28% (n=88) of patients identified as having diabetes through ED HbA1c testing were not coded for a diagnosis of diabetes on discharge
Opportunistic testing for diabetes is effective as almost a third of individuals tested had undiagnosed diabetes. In addition, more than a quarter of individuals were at risk of developing diabetes. Early detection provides an opportunity to initiate preventative measures such as NSW Government’s ‘Get Healthy’ program.