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Inpatient HbA1c testing: a prospective observational study.

Natalie Nanayakkara1, Hang Nguyen2, Leonid Churilov3

  • 1Department of Endocrinology , Austin Health ,  Melbourne, Victoria , Australia.

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|September 18, 2015
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Summary

This study found that 34% of older inpatients have diabetes, with 1 in 6 cases unrecognized. While diabetes was linked to lower 6-month mortality, glycemic control and hospital outcomes were similar across groups.

Keywords:
HbA1cHospital CareQuality ImprovementTesting

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Area of Science:

  • Geriatric Medicine
  • Endocrinology
  • Public Health

Background:

  • Diabetes mellitus is a significant comorbidity in hospitalized older adults.
  • Early identification and management of diabetes are crucial for improving patient outcomes.

Purpose of the Study:

  • To determine the prevalence of unrecognized diabetes, known diabetes, and poor glycemic control in inpatients aged 54 years and older using glycated hemoglobin (HbA1c) testing.
  • To evaluate 6-month outcomes, including mortality, intensive care unit admission, mechanical ventilation, and readmission, for these patient groups.
  • To assess the independent association of diabetes with these 6-month outcomes.

Main Methods:

  • A prospective observational cohort study was conducted with 5082 inpatients aged 54 years and older.
  • HbA1c levels were measured on admission, and previous diabetes diagnoses were confirmed via medical records.
  • Patients were followed for 6 months to assess clinical outcomes.

Main Results:

  • The overall prevalence of diabetes (known and unrecognized) was 34%, with 5% of cases being previously unrecognized.
  • Poor glycemic control (HbA1c ≥8.5%) was observed in 17% of patients with an HbA1c >6.5%.
  • Patients with previously known diabetes had significantly lower 6-month mortality (OR 0.69, p=0.001) compared to those without diabetes, after adjusting for covariates. No significant differences were found in ICU admission, mechanical ventilation, or readmission rates.

Conclusions:

  • Approximately one-third of hospitalized older adults have diabetes, with a substantial proportion unrecognized.
  • Poor glycemic control is prevalent in this inpatient population.
  • Diabetes, particularly previously known diabetes, is independently associated with reduced 6-month mortality, although other short-term hospital outcomes are not significantly different.