Using Automated HbA1c Testing to Detect Diabetes Mellitus in Orthopedic Inpatients and Its Effect on Outcomes
The prevalence of diabetes is rising, and people with diabetes have higher rates of musculoskeletal-related comorbidities. HbA1c testing is a superior option for diabetes diagnosis in the inpatient setting. This study aimed to (i) demonstrate the feasibility of routine HbA1c testing to detect the pr...
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| creator | Ekinci, Elif I Kong, Alvin Churilov, Leonid Nanayakkara, Natalie Chiu, Wei Ling Sumithran, Priya Djukiadmodjo, Frida Premaratne, Erosha Owen-Jones, Elizabeth Hart, Graeme Kevin Robbins, Raymond Hardidge, Andrew Johnson, Douglas Baker, Scott T Zajac, Jeffrey D |
| description | The prevalence of diabetes is rising, and people with diabetes have higher rates of musculoskeletal-related comorbidities. HbA1c testing is a superior option for diabetes diagnosis in the inpatient setting. This study aimed to (i) demonstrate the feasibility of routine HbA1c testing to detect the presence of diabetes mellitus, (ii) to determine the prevalence of diabetes in orthopedic inpatients and (iii) to assess the association between diabetes and hospital outcomes and post-operative complications in orthopedic inpatients.
All patients aged ≥54 years admitted to Austin Health between July 2013 and January 2014 had routine automated HbA1c measurements using automated clinical information systems (CERNER). Patients with HbA1c ≥6.5% were diagnosed with diabetes. Baseline demographic and clinical data were obtained from hospital records.
Of the 416 orthopedic inpatients included in this study, 22% (n = 93) were known to have diabetes, 4% (n = 15) had previously unrecognized diabetes and 74% (n = 308) did not have diabetes. Patients with diabetes had significantly higher Charlson comorbidity scores compared to patients without diabetes (median, IQR; 1 [0,2] vs 0 [0,0], p |
| doi_str_mv | 10.1371/journal.pone.0168471 |
| format | Article |
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All patients aged ≥54 years admitted to Austin Health between July 2013 and January 2014 had routine automated HbA1c measurements using automated clinical information systems (CERNER). Patients with HbA1c ≥6.5% were diagnosed with diabetes. Baseline demographic and clinical data were obtained from hospital records.
Of the 416 orthopedic inpatients included in this study, 22% (n = 93) were known to have diabetes, 4% (n = 15) had previously unrecognized diabetes and 74% (n = 308) did not have diabetes. Patients with diabetes had significantly higher Charlson comorbidity scores compared to patients without diabetes (median, IQR; 1 [0,2] vs 0 [0,0], p<0.001). After adjusting for age, gender, comorbidity score and estimated glomerular filtration rate, no significant differences in the length of stay (IRR = 0.92; 95%CI: 0.79-1.07; p = 0.280), rates of intensive care unit admission (OR = 1.04; 95%CI: 0.42-2.60, p = 0.934), 6-month mortality (OR = 0.52; 95%CI: 0.17-1.60, p = 0.252), 6-month hospital readmission (OR = 0.93; 95%CI: 0.46-1.87; p = 0.828) or any post-operative complications (OR = 0.98; 95%CI: 0.53-1.80; p = 0.944) were observed between patients with and without diabetes.
Routine HbA1c measurement using CERNER allows for rapid identification of inpatients admitted with diabetes. More than one in four patients admitted to a tertiary hospital orthopedic ward have diabetes. No statistically significant differences in the rates of hospital outcomes and post-operative complications were identified between patients with and without diabetes.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0168471</identifier><identifier>PMID: 28060831</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Automation ; Biology and life sciences ; Care and treatment ; Complications ; Demographics ; Diabetes ; Diabetes Complications ; Diabetes mellitus ; Diabetes Mellitus - blood ; Diabetes Mellitus - diagnosis ; Diabetes Mellitus - epidemiology ; Diagnosis ; Diagnostic Tests, Routine ; Feasibility Studies ; Female ; Glomerular filtration rate ; Glucose ; Glycated Hemoglobin A - analysis ; Glycosylated hemoglobin ; Health screening ; Hemoglobin ; Hospitalization ; Humans ; Information systems ; Inpatients ; Joint surgery ; Male ; Measurement ; Medical diagnosis ; Medical records ; Medicine and Health Sciences ; Middle Aged ; Mortality ; Orthopedic Procedures ; Outcome Assessment (Health Care) ; Patients ; Physiological aspects ; Prevalence ; Prospective Studies ; Statistical analysis</subject><ispartof>PloS one, 2017-01, Vol.12 (1), p.e0168471-e0168471</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 Ekinci et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2017 Ekinci et al 2017 Ekinci et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c725t-626d430fd912e00aed572f50a9badfde975d43993e8fe1ed955327cadec540723</citedby><cites>FETCH-LOGICAL-c725t-626d430fd912e00aed572f50a9badfde975d43993e8fe1ed955327cadec540723</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5218571/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5218571/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2097,2916,23848,27906,27907,53773,53775,79350,79351</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28060831$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Bencharit, Sompop</contributor><creatorcontrib>Ekinci, Elif I</creatorcontrib><creatorcontrib>Kong, Alvin</creatorcontrib><creatorcontrib>Churilov, Leonid</creatorcontrib><creatorcontrib>Nanayakkara, Natalie</creatorcontrib><creatorcontrib>Chiu, Wei Ling</creatorcontrib><creatorcontrib>Sumithran, Priya</creatorcontrib><creatorcontrib>Djukiadmodjo, Frida</creatorcontrib><creatorcontrib>Premaratne, Erosha</creatorcontrib><creatorcontrib>Owen-Jones, Elizabeth</creatorcontrib><creatorcontrib>Hart, Graeme Kevin</creatorcontrib><creatorcontrib>Robbins, Raymond</creatorcontrib><creatorcontrib>Hardidge, Andrew</creatorcontrib><creatorcontrib>Johnson, Douglas</creatorcontrib><creatorcontrib>Baker, Scott T</creatorcontrib><creatorcontrib>Zajac, Jeffrey D</creatorcontrib><title>Using Automated HbA1c Testing to Detect Diabetes Mellitus in Orthopedic Inpatients and Its Effect on Outcomes</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The prevalence of diabetes is rising, and people with diabetes have higher rates of musculoskeletal-related comorbidities. HbA1c testing is a superior option for diabetes diagnosis in the inpatient setting. This study aimed to (i) demonstrate the feasibility of routine HbA1c testing to detect the presence of diabetes mellitus, (ii) to determine the prevalence of diabetes in orthopedic inpatients and (iii) to assess the association between diabetes and hospital outcomes and post-operative complications in orthopedic inpatients.
All patients aged ≥54 years admitted to Austin Health between July 2013 and January 2014 had routine automated HbA1c measurements using automated clinical information systems (CERNER). Patients with HbA1c ≥6.5% were diagnosed with diabetes. Baseline demographic and clinical data were obtained from hospital records.
Of the 416 orthopedic inpatients included in this study, 22% (n = 93) were known to have diabetes, 4% (n = 15) had previously unrecognized diabetes and 74% (n = 308) did not have diabetes. Patients with diabetes had significantly higher Charlson comorbidity scores compared to patients without diabetes (median, IQR; 1 [0,2] vs 0 [0,0], p<0.001). After adjusting for age, gender, comorbidity score and estimated glomerular filtration rate, no significant differences in the length of stay (IRR = 0.92; 95%CI: 0.79-1.07; p = 0.280), rates of intensive care unit admission (OR = 1.04; 95%CI: 0.42-2.60, p = 0.934), 6-month mortality (OR = 0.52; 95%CI: 0.17-1.60, p = 0.252), 6-month hospital readmission (OR = 0.93; 95%CI: 0.46-1.87; p = 0.828) or any post-operative complications (OR = 0.98; 95%CI: 0.53-1.80; p = 0.944) were observed between patients with and without diabetes.
Routine HbA1c measurement using CERNER allows for rapid identification of inpatients admitted with diabetes. More than one in four patients admitted to a tertiary hospital orthopedic ward have diabetes. No statistically significant differences in the rates of hospital outcomes and post-operative complications were identified between patients with and without diabetes.</description><subject>Automation</subject><subject>Biology and life sciences</subject><subject>Care and treatment</subject><subject>Complications</subject><subject>Demographics</subject><subject>Diabetes</subject><subject>Diabetes Complications</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus - blood</subject><subject>Diabetes Mellitus - diagnosis</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Diagnosis</subject><subject>Diagnostic Tests, Routine</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Glomerular filtration rate</subject><subject>Glucose</subject><subject>Glycated Hemoglobin A - analysis</subject><subject>Glycosylated hemoglobin</subject><subject>Health screening</subject><subject>Hemoglobin</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Information systems</subject><subject>Inpatients</subject><subject>Joint surgery</subject><subject>Male</subject><subject>Measurement</subject><subject>Medical diagnosis</subject><subject>Medical records</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Orthopedic Procedures</subject><subject>Outcome Assessment (Health Care)</subject><subject>Patients</subject><subject>Physiological aspects</subject><subject>Prevalence</subject><subject>Prospective Studies</subject><subject>Statistical 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Automated HbA1c Testing to Detect Diabetes Mellitus in Orthopedic Inpatients and Its Effect on Outcomes</title><author>Ekinci, Elif I ; Kong, Alvin ; Churilov, Leonid ; Nanayakkara, Natalie ; Chiu, Wei Ling ; Sumithran, Priya ; Djukiadmodjo, Frida ; Premaratne, Erosha ; Owen-Jones, Elizabeth ; Hart, Graeme Kevin ; Robbins, Raymond ; Hardidge, Andrew ; Johnson, Douglas ; Baker, Scott T ; Zajac, Jeffrey D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c725t-626d430fd912e00aed572f50a9badfde975d43993e8fe1ed955327cadec540723</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Automation</topic><topic>Biology and life sciences</topic><topic>Care and treatment</topic><topic>Complications</topic><topic>Demographics</topic><topic>Diabetes</topic><topic>Diabetes Complications</topic><topic>Diabetes mellitus</topic><topic>Diabetes Mellitus - blood</topic><topic>Diabetes Mellitus - 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Raymond</au><au>Hardidge, Andrew</au><au>Johnson, Douglas</au><au>Baker, Scott T</au><au>Zajac, Jeffrey D</au><au>Bencharit, Sompop</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Using Automated HbA1c Testing to Detect Diabetes Mellitus in Orthopedic Inpatients and Its Effect on Outcomes</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2017-01-06</date><risdate>2017</risdate><volume>12</volume><issue>1</issue><spage>e0168471</spage><epage>e0168471</epage><pages>e0168471-e0168471</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The prevalence of diabetes is rising, and people with diabetes have higher rates of musculoskeletal-related comorbidities. HbA1c testing is a superior option for diabetes diagnosis in the inpatient setting. This study aimed to (i) demonstrate the feasibility of routine HbA1c testing to detect the presence of diabetes mellitus, (ii) to determine the prevalence of diabetes in orthopedic inpatients and (iii) to assess the association between diabetes and hospital outcomes and post-operative complications in orthopedic inpatients.
All patients aged ≥54 years admitted to Austin Health between July 2013 and January 2014 had routine automated HbA1c measurements using automated clinical information systems (CERNER). Patients with HbA1c ≥6.5% were diagnosed with diabetes. Baseline demographic and clinical data were obtained from hospital records.
Of the 416 orthopedic inpatients included in this study, 22% (n = 93) were known to have diabetes, 4% (n = 15) had previously unrecognized diabetes and 74% (n = 308) did not have diabetes. Patients with diabetes had significantly higher Charlson comorbidity scores compared to patients without diabetes (median, IQR; 1 [0,2] vs 0 [0,0], p<0.001). After adjusting for age, gender, comorbidity score and estimated glomerular filtration rate, no significant differences in the length of stay (IRR = 0.92; 95%CI: 0.79-1.07; p = 0.280), rates of intensive care unit admission (OR = 1.04; 95%CI: 0.42-2.60, p = 0.934), 6-month mortality (OR = 0.52; 95%CI: 0.17-1.60, p = 0.252), 6-month hospital readmission (OR = 0.93; 95%CI: 0.46-1.87; p = 0.828) or any post-operative complications (OR = 0.98; 95%CI: 0.53-1.80; p = 0.944) were observed between patients with and without diabetes.
Routine HbA1c measurement using CERNER allows for rapid identification of inpatients admitted with diabetes. More than one in four patients admitted to a tertiary hospital orthopedic ward have diabetes. No statistically significant differences in the rates of hospital outcomes and post-operative complications were identified between patients with and without diabetes.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28060831</pmid><doi>10.1371/journal.pone.0168471</doi><tpages>e0168471</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2017-01, Vol.12 (1), p.e0168471-e0168471 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1856128622 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Automation Biology and life sciences Care and treatment Complications Demographics Diabetes Diabetes Complications Diabetes mellitus Diabetes Mellitus - blood Diabetes Mellitus - diagnosis Diabetes Mellitus - epidemiology Diagnosis Diagnostic Tests, Routine Feasibility Studies Female Glomerular filtration rate Glucose Glycated Hemoglobin A - analysis Glycosylated hemoglobin Health screening Hemoglobin Hospitalization Humans Information systems Inpatients Joint surgery Male Measurement Medical diagnosis Medical records Medicine and Health Sciences Middle Aged Mortality Orthopedic Procedures Outcome Assessment (Health Care) Patients Physiological aspects Prevalence Prospective Studies Statistical analysis |
| title | Using Automated HbA1c Testing to Detect Diabetes Mellitus in Orthopedic Inpatients and Its Effect on Outcomes |
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