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Diabetes Detection and Communication among Patients Admitted through the Emergency Department of a Public Hospital

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  • Osuagwu Uchechukwu Levi

    (Diabetes, Obesity and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
    African Vision Research Institute, University of Kwazulu-Natal, Durban 4001, South Africa)

  • Frederick Webb

    (School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia)

  • David Simmons

    (Diabetes, Obesity and Metabolism Translational Research Unit, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
    Campbelltown Hospital Diabetes Services and Western Sydney University, Campbelltown, NSW 2560, Australia)

Abstract

Early identification/diagnosis of diabetes and frequent monitoring of hyperglycemia reduces hospitalizations and diabetes-related complications. The present study investigated the proportion of older adults coded with diabetes or newly diagnosed during their admissions and assessed discharge summary content for diabetes-related information. The study used electronic data on 4796 individuals aged ≥60 years admitted through the emergency department (ED) of a public hospital from 2017 to 2018 extracted using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM code). The proportion of admitted patients who were diagnosed with diabetes over a one-year period, proportion with glycated hemoglobin A1c (HbA1c) and random blood glucose (RBG) test performed during their stay, length of stay, discharge summary information and the factors associated with elevated HbA1c (>7%/53 mmol/mol) were investigated. In total, 8.6% of ED presentations to the hospital were coded with diabetes, excluding gestational consisting of 879 patients (449 males, 430 females) aged ≥ 60 years (74.6 ± 8.9 years). In total, 98% had type 2 diabetes (n = 863), 53% were Australian-born (n = 467), and the mean body mass index (BMI, 31 ± 7 kg/m 2 ; n = 499, 56.8%), RBG (9.8 ± 5.2 mmol/L; n = 824, 93.7%) and HbA1c (8.0 ± 2.0%; n = 137, 15.6%) and length of stay (6.7 ± 25.4 days) were similar between gender, age, and nationality ( p > 0.05). Three coded patients (0.3%) were newly diagnosed during the admission. In total, 86% had elevated HbA1c, but this was recorded in 20% of discharge summaries. Patients who are on a combination therapy (adjusted odds ratio 23%, 95% confidence intervals: 7%/38%), those on SGLT2 Inhibitors (aOR, 14%: 2%/26%) or had a change in medication (aOR, 40%: 22%/59%) had lower odds of having elevated HbA1c during admission. The low diagnosis rate of diabetes and the lack of clinical assessment of HbA1c in older adults admitted through the ED of a South Western Sydney public hospital suggest that many patients with diabetes either remain undiagnosed even during admission and/or are going to the ED with unknown diabetes that is unidentified with current practices. The clinically important HbA1c results were only infrequently communicated with general practitioners (GPs).

Suggested Citation

  • Osuagwu Uchechukwu Levi & Frederick Webb & David Simmons, 2020. "Diabetes Detection and Communication among Patients Admitted through the Emergency Department of a Public Hospital," IJERPH, MDPI, vol. 17(3), pages 1-13, February.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:3:p:980-:d:316509
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    References listed on IDEAS

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    1. Manel Mata-Cases & Marc Casajuana & Josep Franch-Nadal & Aina Casellas & Conxa Castell & Irene Vinagre & Dídac Mauricio & Bonaventura Bolíbar, 2016. "Direct medical costs attributable to type 2 diabetes mellitus: a population-based study in Catalonia, Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(8), pages 1001-1010, November.
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