Screening for diabetes on a vascular ward: lessons from an audit

Owing to the high prevalence of diabetes mellitus in patients with peripheral arterial disease, screening for this disorder is necessary on a vascular ward. Our current practice of random plasma glucose (RPG) testing on every admission was reviewed. This test, although crude, excludes diabetes if the cutoff level is set as low as 6.0 mmol/L. A total of 36% of our patients had an abnormal result, but this was not further acted upon. A further 19% had no test result recorded at all. This practice is inadequate and has resulted in the following implementations: (1) every patient with clinical evidence of arterial disease should have their RPG level measured; (2) patients with a level > 6.0 mmol/L should have a fasting plasma glucose level estimated; and (3) patients with an abnormal fasting plasma glucose level should be referred to the diabetic clinic.