1. Screening for type 2 diabetes with random finger-prick glucose and bedside HbA1c in an Australian emergency department.
- Author
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Jelinek, George A, Weiland, Tracey J, Moore, Gaye, Tan, Grace, Maslin, Marg, Bowman, Kath, Ward, Glenn, and O'Dea, Kerin
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TYPE 2 diabetes prevention , *ANALYSIS of variance , *BLOOD sugar , *COMPUTER software , *CONFIDENCE intervals , *EMERGENCY medical services , *GLYCOSYLATED hemoglobin , *HOSPITAL emergency services , *INFERENCE (Logic) , *INTERVIEWING , *LONGITUDINAL method , *MEDICAL screening , *TYPE 2 diabetes , *PATIENTS , *RESEARCH funding , *STATISTICAL sampling , *STATISTICAL hypothesis testing , *STATISTICS , *DATA analysis , *DISEASE prevalence , *CROSS-sectional method , *BLOOD , *EPIDEMIOLOGY - Abstract
Objective: To determine if screening for undiagnosed type 2 diabetes mellitus (T2DM) and pre-diabetes is feasible in an Australian ED; to estimate the prevalence of T2DM and pre-diabetes in the Australian ED population. Methods: Prospective cross-sectional prevalence survey in the ED of St Vincent's Hospital, Melbourne, an adult, tertiary referral centre seeing approximately 40 000 patients annually. A convenience sample of adult patients was screened with finger-prick random blood glucose and glycosylated haemoglobin (HbA1c); those over 6.0 mmol/L and 6.0% were referred for oral glucose tolerance test (OGTT). Diagnoses of T2DM and pre-diabetes were made according to World Health Organization definitions. Those not attending for OGTT were contacted by phone, and interviewed about their reasons. Results: Seven hundred and twenty-five patients were recruited; 135 (18.6%; 95% confidence intervals [CI] 15.9-21.6%) had known T2DM, leaving 590 screened, of whom 210 screened positive. Of the 192 referred for OGTT, 147 (77%) did not attend despite several telephone reminders. Of the 45 (23%) completing OGTT, pre-diabetes was present in eight (17.8%; 95% CI 9.0-31.6%) and T2DM in six (13.3%; 95% CI 5.9-26.6%). Many people interviewed (18/86, 21%) did not attend for OGTT on the advice of their doctors. Conclusions: This inner city tertiary ED has a high prevalence of T2DM, diagnosed and undiagnosed, with as much as half our population possibly affected. Although ED screening might have a high yield, opportunistic screening is not feasible, with difficulties in staff engagement and patient follow up for diagnostic testing. Future studies might consider finger-prick fasting blood glucose through a patient's general practitioner for diagnosis. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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