Opportunistic screening for diabetes among urban Aboriginal adults during emergency department attendance

Aboriginal people have a high risk of type 2 diabetes (T2DM). Routine opportunistic testing using glycated hemoglobin (HbA1c) for diabetes in the emergency department (ED) offers an opportunity to detect undiagnosed diabetes and evaluate glycaemia for pre-existing diabetes.

To evaluate the prevalence of pre-existing diabetes and assess random blood glucose (RBG) and HbA1c as screening tools for undiagnosed diabetes in Aboriginal people attending the ED.

Demographic and RBG data were extracted for all Aboriginal adults presenting to a Sydney hospital ED over 6 months. Practitioners requested blood tests as per routine care, and in the final 3 months, HbA1c was automatically added to routine venous sampling. The primary outcome was change in diabetes diagnosis with the addition of HbA1c.

Overall, 1640 adult Aboriginal patients presented to the ED over 6 months (4.1% of all presentations), including 734 unique individuals tested during routine care. The prevalence of pre-existing T2DM was 12.0% (n = 88). Among those without known diabetes, 1.4% (n = 9) had glucose readings ≥11.1 mmol/L and 14.3% (n = 90) had glucose readings 7.0-11.0 mmol/L. For those without known diabetes with HbA1c measurement, there were 2.7% (n = 8) with HbA1c ≥6.5% and 4% (n = 12) with HbA1c 6.0%-6.4%. There was no overlap between those who had an HbA1c ≥6.5% and RBG ≥11.1 mmol/L.

There was a high prevalence of pre-existing diabetes among Aboriginal adults attending the ED. New diabetes diagnosis in the ED based on RBG or HbA1c was not common. Confirmatory testing for diabetes should be recommended to the general practitioners of patients in whom elevated HbA1c or RBG are identified.