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.
Int J Environ Res Public Health. 2020 Feb 4;17(3):980. doi: 10.3390/ijerph17030980.
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; 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 ( > 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).
早期识别/诊断糖尿病和频繁监测高血糖可减少住院和糖尿病相关并发症。本研究调查了在住院期间被诊断为糖尿病或新诊断为糖尿病的老年患者的比例，并评估了出院小结中与糖尿病相关的信息。该研究使用了 2017 年至 2018 年通过公立医院急诊科（ED）入院的 4796 名年龄≥60 岁的个体的电子数据，这些数据是使用国际疾病分类，第十次修订版，临床修正（ICD-10-CM 代码）提取的。调查了在一年期间被诊断为糖尿病的住院患者比例、在住院期间进行糖化血红蛋白（HbA1c）和随机血糖（RBG）检测的患者比例、住院时间、出院小结信息以及与 HbA1c 升高（>7%/53mmol/mol）相关的因素。在该医院急诊科就诊的患者中，有 8.6%被编码为患有糖尿病，不包括妊娠期，共有 879 例患者（449 名男性，430 名女性）年龄≥60 岁（74.6±8.9 岁）。其中 98%为 2 型糖尿病（n=863），53%为澳大利亚出生（n=467），平均体重指数（BMI，31±7kg/m；n=499，56.8%）、RBG（9.8±5.2mmol/L；n=824，93.7%）和 HbA1c（8.0±2.0%；n=137，15.6%）和住院时间（6.7±25.4 天）在性别、年龄和国籍之间相似（>0.05）。有 3 名患者（0.3%）在住院期间被新诊断为糖尿病。共有 86%的患者 HbA1c 升高，但只有 20%的出院小结中记录了这一情况。接受联合治疗的患者（调整后的优势比 23%，95%置信区间：7%/38%）、接受 SGLT2 抑制剂治疗的患者（aOR，14%：2%/26%）或药物治疗发生变化的患者（aOR，40%：22%/59%）HbA1c 升高的可能性较低。在西南悉尼公立医院急诊科就诊的老年患者中，糖尿病的低诊断率和 HbA1c 的临床评估缺乏表明，许多糖尿病患者即使在住院期间也未被诊断，或者是因为未知的糖尿病而前往急诊科就诊，而目前的治疗方法并未识别出这些患者。临床上重要的 HbA1c 结果仅偶尔与全科医生（GP）沟通。
