Emergency Medicine, North Shore-LIJ Health System, Queens, NY, USA.
Diabetes Metab Res Rev. 2012 Oct;28(7):603-7. doi: 10.1002/dmrr.2315.
To improve diabetes screening efforts, the American Diabetes Association now recommends haemoglobin A(1c) (HbA(1c)) as a diagnostic test, increasing access to patients found in acute care environments. However, the influence of acute illness and care on HbA(1c) levels has not been well studied. To address this, we evaluated for intra-patient differences in HbA(1c) assessed in the emergency department (ED) and after recovery from the acute illness.
Adult patients with no known history of diabetes were tested for HbA(1c) during an ED and scheduled follow-up visit. HbA(1c) differences between the two visits were compared using limits of agreement with 95% confidence intervals. The frequency of individuals who changed diagnostic categories (using ≥6.5% to classify newly diagnosed diabetes) from ED to follow-up was determined.
A total of 589 patients were included with a mean age of 50 years, and 57/589 (9.7%) had an ED HbA(1c) ≥ 6.5% with the average follow-up visit 45 days after the ED visit. The mean ED HbA(1c) was 5.67% (±0.86), and the follow-up HbA(1c) was 5.65% (±0.89), (difference -0.0129%, 95% limits of agreement -0.740, 0.714). The ED and follow-up HbA(1c) was highly correlated (r² = 0.829). Although on follow-up almost all patients were classified in the same diagnostic category as in the ED, 17 patients had an HbA(1c) ≥ 6.5% in the ED and an HbA(1c) < 6.5%. On follow-up most patients (14/17) still fell in an abnormal range (6.0-6.5%).
The HbA(1c) value is not substantially affected by acute illness and is feasible as a screening assay for diabetes in the acute care setting such as an ED.
为了改善糖尿病筛查工作，美国糖尿病协会现在推荐血红蛋白 A1c（HbA1c）作为诊断检测，增加了在急性护理环境中发现的患者的就诊机会。然而，急性疾病和治疗对 HbA1c 水平的影响尚未得到很好的研究。为了解决这个问题，我们评估了在急诊科（ED）和急性疾病康复后评估的患者内 HbA1c 的差异。
在 ED 和计划的随访期间，对无已知糖尿病病史的成年患者进行 HbA1c 检测。使用 95%置信区间的一致性界限比较两次就诊的 HbA1c 差异。确定从 ED 到随访时诊断类别改变（使用≥6.5%来分类新诊断的糖尿病）的个体的频率。
共纳入 589 例患者，平均年龄为 50 岁，57/589（9.7%）在 ED 的 HbA1c ≥ 6.5%，平均随访时间为 ED 就诊后 45 天。ED 的平均 HbA1c 为 5.67%（±0.86），随访时的 HbA1c 为 5.65%（±0.89），（差异-0.0129%，95%一致性界限-0.740，0.714）。ED 和随访的 HbA1c 高度相关（r² = 0.829）。尽管在随访时，几乎所有患者都被归入与 ED 相同的诊断类别，但有 17 名患者在 ED 时的 HbA1c ≥ 6.5%，而在 HbA1c < 6.5%。在随访时，大多数患者（14/17）仍处于异常范围（6.0-6.5%）。
HbA1c 值不会受到急性疾病的实质性影响，并且可以作为 ED 等急性护理环境中的糖尿病筛查检测。
