ED screening program identifies undiagnosed diabetes cases
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An ED screening program identified patients with undiagnosed prediabetes and type 2 diabetes or undermanaged disease, particularly among racial and ethnic minorities and patients with low income, researchers reported in JAMA Network Open.
“Regarding type 2 diabetes, a few studies have conducted short-term screening of all ED patients,” Kirstie K. Danielson, PhD, associate professor of endocrinology, diabetes and metabolism in the department of medicine at the University of Illinois, Chicago, and colleagues wrote. “To our knowledge, ED screening for type 2 diabetes in underserved populations that built into daily clinical care and uses clinical recommendations has not been developed.”
Researchers conducted this pilot program in an ED in Chicago from February to April 2021. Using a best practice alert built into the electronic medical record, researchers identified patients for diabetes screening based on American Diabetes Association criteria: all adults aged 45 years or older, and those aged 18 to 44 years who had a BMI of 25 kg/m2 and no prior diabetes diagnosis and no HbA1c record for the past 3 years. Of 8,441 total patients who visited the ED, 1,085 were flagged as at risk for type 2 diabetes. Of these patients, 758 had prediabetes, 265 had diabetes and 62 had severe diabetes.
Researchers were able to follow-up with 352 of these patients for HbA1c information: 264 with prediabetes (mean age, 51.7 years; 56.8% women) and 88 with type 2 diabetes (mean age, 53.8 years; 47.7% women). Overall, 19.6% of patients were Hispanic, 64.8% were non-Hispanic Black, 9.7% were non-Hispanic white and 6% were non-Hispanic of other race.
Median income of all patients’ ZIP codes was at the 44th percentile of U.S. income. In addition, 50% of patients had public insurance and 4% were uninsured. Of note, 25% of patients self-reported that they were diagnosed with prediabetes or type 2 diabetes before the study, but only 58% reported receiving treatment for their disease, according to the researchers.
“The pilot sample reached by telephone was likely biased toward higher socioeconomic status, indicating those not reached are more likely underserved,” the researchers wrote. “Next steps involve testing implementation strategies to link these new patients to diabetes education and care.”
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