Identification of Previously Undiagnosed Diabetes and Prediabetes in the Inpatient Setting Using Risk Factor and Hemoglobin A1C Screening

Abstract

Background: Identifying diabetes early in its progression can present opportunities to intervene with education and medical management to prevent diabetes-related complications. Objective: The primary objective was to determine the incidence of diabetes in hospitalized patients without insurance or routine outpatient care using recommendations by the American Diabetes Association (ADA) Standards of Medical Care in Diabetes for diabetes risk screening and diagnosis. Methods: This study was conducted at a community hospital in Abilene, Texas. Hospitalized patients were screened if they had self-payer status and did not have a primary care physician. If patients met screening criteria based on risk factors listed in the ADA guidelines, a hemoglobin A_1C test and fasting plasma glucose test were completed during hospitalization. Patients found to have diabetes were referred for outpatient education and management of diabetes. Data to determine the incidence of diabetes diagnosis were collected retrospectively. Results: A total of 460 patients were screened for inclusion. Of the 92 patients included in the analysis, 8.7% (n = 8) were identified as having diabetes and 39.1% (n = 36) with prediabetes. Age and hypertension were independently positively correlated with increased risk for diabetes (P = 0.002; P = 0.045). Conclusions: Using risk factor screening based on ADA recommendations in the inpatient setting did not identify a significant number of patients with diabetes. This study found specific risk factors to be correlated with diagnosis of diabetes. Rather than using routine screening based on the number of risk factors, the presence of highly correlated risk factors may be an indication for diabetes screening.