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Unrecognized diabetes among hospitalized patients
C S Levetan1, M Passaro, K Jablonski
1Medlantic Research Institute, Washington, DC 20003, USA.
Insights
Many hospitalized patients with hyperglycemia lack a diabetes diagnosis. Medical records often fail to address this, missing opportunities for early diabetes detection and treatment.
Area of Science:
- Internal Medicine
- Endocrinology
- Hospital Administration
Background:
- Hyperglycemia is common in hospitalized patients.
- Undiagnosed diabetes contributes to significant health burdens.
- Early detection of diabetes improves patient outcomes.
Purpose of the Study:
- To assess hospital care for patients with hyperglycemia but no prior diabetes diagnosis.
- To identify missed opportunities for diabetes diagnosis and management in hospitalized patients.
Main Methods:
- Retrospective evaluation of 1,034 hospitalized adult patients.
- Identification of patients with plasma glucose > 200 mg/dl.
- Analysis of medical records for hyperglycemia management and diabetes documentation.
Main Results:
- 37.5% of medical and 33% of surgical hyperglycemic patients lacked a prior diabetes diagnosis.
- Most patients had elevated glucose levels and received some treatment (insulin, glucose monitoring).
- Medical records rarely commented on hyperglycemia or documented diabetes (7.3%).
Conclusions:
- Hospitalized hyperglycemic patients frequently have unrecognized diabetes.
- Current documentation practices miss opportunities for early diabetes diagnosis.
- Systematic evaluation of hyperglycemic patients can facilitate earlier detection and treatment initiation.
Objective:
To evaluate the hospital care rendered to hyperglycemic individuals who did not have a diagnosis of diabetes before admission.
Research Design And Methods:
A total of 1,034 consecutively hospitalized adult patients at a 750-bed inner-city teaching hospital were evaluated. Patients with one or more plasma glucose values > 200 mg/dl were identified by the laboratory data system on a daily basis. Patients without a diagnosis of diabetes at the time of admission were evaluated to determine if and how physicians addressed the hyperglycemia, whether a new diagnosis of diabetes was made during admission, and whether follow-up was planned to address the hyperglycemia.
Results:
After excluding patients who were admitted for a primary diagnosis of diabetes, 37.5% of all hyperglycemic medical patients and 33% of hyperglycemic surgical patients were without a diagnosis of diabetes at the time of admission. These patients had a mean peak glucose of 299 mg/dl, and 66% had two or more elevated values during their hospitalization. Fifty-four percent received insulin therapy, and 59% received bedside glucose monitoring, yet 66% of daily patient progress notes failed to comment on the presence of hyperglycemia or diabetes. Diabetes was documented in only three patients (7.3%) as a possible diagnosis in the daily progress notes.
Conclusions:
Despite marked hyperglycemia, most medical records made no reference to the possibility of unrecognized diabetes. Given the average delay of a decade between the onset and diagnosis of type 2 diabetes, further evaluation of hyperglycemic hospitalized patients may present an important opportunity for earlier detection and the initiation of therapy.