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EDs Miss Opportunity to Get Treatment for Potential Diabetes Patients

TEL AVIV, ISRAEL – Emergency departments might be missing an opportunity to help patients with diabetes receive treatment.

A study published in the International Journal of Clinical Practice sought to assess the prevalence of hyperglycemia in patients presenting to an ED with no known history of diabetes, and to evaluate how often the medical staff recommended those patients follow up with outpatient care.

To do that, Tel Aviv University researchers and colleagues from Israel and the United States performed a cross-sectional study, examining the medical records of adult patients referred to an ED between Nov. 1, 2011, and Jan. 31, 2012. Included were patients with random blood glucose of 140 mg/dL or higher and no known history of diabetes.

Discharge documents were examined for the presence of instructions to conduct further follow-up.

During the time period, 16,784 patients presented to the ED, and 2.4% without known diabetes were determined to be hyperglycemic. Of those, 346 patients had blood glucose levels 140 mg/dL or greater, with 56 patients having blood glucose levels above 200 mg/dL.

Yet, according to the results, only 35 of the 402 included patient files (8.7%) contained instructions for further investigation. No statistically significant differences were discovered in terms of age, sex, or blood glucose levels between those who received a letter for further follow-up compared with those who did not.

“Over 2% of patients who presented to the [ED] were hyperglycemic, without a prior diagnosis of diabetes,” study authors conclude. “A small percent was recommended to have outpatient follow-up. This represents a missed opportunity for earlier diagnosis of diabetes and emphasized the need for raising medical staff awareness concerning abnormal blood glucose and its implication.”

A retrospective review published earlier this year, which used U.S. data, found that hospitals in general are missing an opportunity for early diabetes detection among inpatients because of underuse of glycated hemoglobin testing.