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Can HbA1c detect undiagnosed diabetes in acute medical hospital admissions?

Lookup NU author(s): Dr Aaron Liew

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Abstract

© 2016. Objective: To study hyperglycaemia in acute medical admissions to Irish regional hospital. Research design and methods: From 2005 to 2007, 2061 white Caucasians, aged >18 years, were admitted by 1/7 physicians. Those with diabetes symptoms/complications but no previous record of hyperglycaemia (n =390), underwent OGTT with concurrent HbA1c in representative subgroup (n =148). Comparable data were obtained for 108 primary care patients at risk of diabetes. Results: Diabetes was diagnosed immediately by routine practice in 1% (22/2061) [aged 36 (26-61) years (median IQ range)/55% (12/22) male] with pre-existing diabetes/dysglycaemia present in 19% (390/2061) [69 (58-80) years/60% (235/390) male].Possible diabetes symptoms/complications were identified in 19% [70 (59-79) years/57% (223/390) male] with their HbA1c similar to primary care patients [54 (46-61) years], 5.7 (5.3-6.0)%/39 (34-42)mmol/mol (n =148) vs 5.7 (5.4-6.1)%/39 (36-43)mmol/mol, p =0.35, but lower than those diagnosed on admission, 10.2 (7.4-13.3)%/88 (57-122)mmol/mol, p <0.001. Their fasting plasma glucose (FPG) was similar to primary care patients, 5.2 (4.8-5.7) vs 5.2 (4.8-5.9) mmol/L, p =0.65, but 2hPG higher, 9.0 (7.3-11.4) vs 5.5 (4.4-7.5), p <0.001.HbA1c identified diabetes in 10% (15/148) with 14 confirmed on OGTT but overall 32% (48/148) were in diabetic range on OGTT. The specificity of HbA1c in 2061 admissions was similar to primary care, 99% vs 96%, p =0.20, but sensitivity lower, 38% vs 93%, p <0.001 (63% on FPG/23% on 2hPG, p =0.037, in those with possible symptoms/complications). Conclusion: HbA1c can play a diagnostic role in acute medicine as it diagnosed another 2% of admissions with diabetes but the discrepancy in sensitivity shows that it does not reflect transient/acute hyperglycaemia resulting from the acute medical event.

Publication metadata

Author(s): Manley SE, O'Brien KT, Quinlan D, Round RA, Nightingale PG, Ali F, Durrani BK, Liew A, Luzio SD, Stratton IM, Roberts GA

Publication type: Article

Publication status: Published

Journal: Diabetes Research and Clinical Practice

Year: 2016

Volume: 115

Pages: 106–114

Print publication date: 01/05/2016

Online publication date: 21/01/2016

Acceptance date: 13/01/2016

ISSN (print): 0168-8227

ISSN (electronic): 1872-8227

Publisher: Elsevier Ireland Ltd

URL: https://doi.org/10.1016/j.diabres.2016.01.023

DOI: 10.1016/j.diabres.2016.01.023

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