The potential for utilising in‐hospital glucose measurements to detect individuals at high risk of previously undiagnosed diabetes: Retrospective cohort study
Background Many people with undiagnosed diabetes have hyperglycaemia when admitted to hospital. Inpatient hyperglycaemia can be an indication of diabetes mellitus but can also indicate a stress response. This study reports the extent to which an in‐hospital maximum observed random glucose measuremen...
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| Veröffentlicht in: | Diabetic medicine 2022-10, Vol.39 (10), p.e14918-n/a |
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| creator | Farmer, Andrew J. Shine, Brian Armitage, Laura C. Murphy, Noel James, Tim Guha, Nishan Rea, Rustam |
| description | Background
Many people with undiagnosed diabetes have hyperglycaemia when admitted to hospital. Inpatient hyperglycaemia can be an indication of diabetes mellitus but can also indicate a stress response. This study reports the extent to which an in‐hospital maximum observed random glucose measurement is an indicator of the need for in‐hospital (or subsequent) HbA1c measurement to look for undiagnosed diabetes.
Methods
Blood glucose, HbA1c, age and sex were collected for all adults following admission to a UK NHS trust hospital from 1 January 2019 to 31 December 2020. We restricted the analysis to those participants who were registered with a GP practice that uses the trust laboratory and who had at least some tests requested by those practices since 2008. We stratified individuals according to their maximum in‐hospital glucose measurement and report the number of these with HbA1c measurement ≥48 mmol/mol (6.5%) prior to the index admission, and during and after admission. We calculated an estimated proportion of individuals in each blood glucose stratum without a follow‐up HbA1c who could have undiagnosed diabetes.
Results
In toal, 764,241 glucose measurements were recorded for 81,763 individuals who were admitted to the Oxford University Hospitals Trust. The median (Q1, Q3) age was 70 (56, 81) years, and 53% were males. Of the population, 70.7% of individuals declared themselves to be of White ethnicity, 3.1% of Asian background, and 1.1% of Black background, with 23.1% unstated. Of those individuals, 22,375 (27.4%) had no previous HbA1c measurement recorded. A total of 1689 individuals had a diabetes‐range HbA1c during or after their hospital admission (2.5%) while we estimate an additional 1496 (2.2%) may have undiagnosed diabetes, with the greatest proportion of these having an in‐hospital glucose of ≥15 mmol/L. We estimate that the number needed to detect a possible new case of diabetes falls from 16 (in‐hospital glucose 8 mmol/L to |
| doi_str_mv | 10.1111/dme.14918 |
| format | Article |
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Many people with undiagnosed diabetes have hyperglycaemia when admitted to hospital. Inpatient hyperglycaemia can be an indication of diabetes mellitus but can also indicate a stress response. This study reports the extent to which an in‐hospital maximum observed random glucose measurement is an indicator of the need for in‐hospital (or subsequent) HbA1c measurement to look for undiagnosed diabetes.
Methods
Blood glucose, HbA1c, age and sex were collected for all adults following admission to a UK NHS trust hospital from 1 January 2019 to 31 December 2020. We restricted the analysis to those participants who were registered with a GP practice that uses the trust laboratory and who had at least some tests requested by those practices since 2008. We stratified individuals according to their maximum in‐hospital glucose measurement and report the number of these with HbA1c measurement ≥48 mmol/mol (6.5%) prior to the index admission, and during and after admission. We calculated an estimated proportion of individuals in each blood glucose stratum without a follow‐up HbA1c who could have undiagnosed diabetes.
Results
In toal, 764,241 glucose measurements were recorded for 81,763 individuals who were admitted to the Oxford University Hospitals Trust. The median (Q1, Q3) age was 70 (56, 81) years, and 53% were males. Of the population, 70.7% of individuals declared themselves to be of White ethnicity, 3.1% of Asian background, and 1.1% of Black background, with 23.1% unstated. Of those individuals, 22,375 (27.4%) had no previous HbA1c measurement recorded. A total of 1689 individuals had a diabetes‐range HbA1c during or after their hospital admission (2.5%) while we estimate an additional 1496 (2.2%) may have undiagnosed diabetes, with the greatest proportion of these having an in‐hospital glucose of ≥15 mmol/L. We estimate that the number needed to detect a possible new case of diabetes falls from 16 (in‐hospital glucose 8 mmol/L to <9 mmol/L) to 4 (14 mmol/L to <15 mmol/L).
Conclusion
The number of people who need to be tested to identify an individual who may have diabetes decreases as a testing threshold based on maximum in‐hospital glucose concentration increases. Among those with hyperglycaemia and no previous HbA1c measurement in the diabetes range, there appears to be a lack of subsequent HbA1c measurement. This work identifies the potential for integrating the testing and follow‐up of people, with apparently unrecognised hospital hyperglycaemia across primary and secondary care.</description><identifier>ISSN: 0742-3071</identifier><identifier>EISSN: 1464-5491</identifier><identifier>DOI: 10.1111/dme.14918</identifier><identifier>PMID: 35839301</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Blood Glucose - analysis ; Cohort analysis ; cohort study ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus - diagnosis ; Diabetes Mellitus - epidemiology ; Female ; Glucose ; Glycated Hemoglobin - analysis ; Hospitals, University ; Humans ; Hyperglycemia ; Hyperglycemia - diagnosis ; Hyperglycemia - epidemiology ; Inpatient care ; in‐hospital testing, diagnosis, digital health ; Male ; Medical diagnosis ; Medical tests ; Retrospective Studies</subject><ispartof>Diabetic medicine, 2022-10, Vol.39 (10), p.e14918-n/a</ispartof><rights>2022 The Authors. published by John Wiley & Sons Ltd on behalf of Diabetes UK.</rights><rights>2022 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.</rights><rights>2022. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3888-8898aea787a381f4e3a98d5ae36ba39910b9662bdfb3bff6909cc603a47754b03</citedby><cites>FETCH-LOGICAL-c3888-8898aea787a381f4e3a98d5ae36ba39910b9662bdfb3bff6909cc603a47754b03</cites><orcidid>0000-0002-6170-4402 ; 0000-0001-6515-8325</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fdme.14918$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fdme.14918$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35839301$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Farmer, Andrew J.</creatorcontrib><creatorcontrib>Shine, Brian</creatorcontrib><creatorcontrib>Armitage, Laura C.</creatorcontrib><creatorcontrib>Murphy, Noel</creatorcontrib><creatorcontrib>James, Tim</creatorcontrib><creatorcontrib>Guha, Nishan</creatorcontrib><creatorcontrib>Rea, Rustam</creatorcontrib><title>The potential for utilising in‐hospital glucose measurements to detect individuals at high risk of previously undiagnosed diabetes: Retrospective cohort study</title><title>Diabetic medicine</title><addtitle>Diabet Med</addtitle><description>Background
Many people with undiagnosed diabetes have hyperglycaemia when admitted to hospital. Inpatient hyperglycaemia can be an indication of diabetes mellitus but can also indicate a stress response. This study reports the extent to which an in‐hospital maximum observed random glucose measurement is an indicator of the need for in‐hospital (or subsequent) HbA1c measurement to look for undiagnosed diabetes.
Methods
Blood glucose, HbA1c, age and sex were collected for all adults following admission to a UK NHS trust hospital from 1 January 2019 to 31 December 2020. We restricted the analysis to those participants who were registered with a GP practice that uses the trust laboratory and who had at least some tests requested by those practices since 2008. We stratified individuals according to their maximum in‐hospital glucose measurement and report the number of these with HbA1c measurement ≥48 mmol/mol (6.5%) prior to the index admission, and during and after admission. We calculated an estimated proportion of individuals in each blood glucose stratum without a follow‐up HbA1c who could have undiagnosed diabetes.
Results
In toal, 764,241 glucose measurements were recorded for 81,763 individuals who were admitted to the Oxford University Hospitals Trust. The median (Q1, Q3) age was 70 (56, 81) years, and 53% were males. Of the population, 70.7% of individuals declared themselves to be of White ethnicity, 3.1% of Asian background, and 1.1% of Black background, with 23.1% unstated. Of those individuals, 22,375 (27.4%) had no previous HbA1c measurement recorded. A total of 1689 individuals had a diabetes‐range HbA1c during or after their hospital admission (2.5%) while we estimate an additional 1496 (2.2%) may have undiagnosed diabetes, with the greatest proportion of these having an in‐hospital glucose of ≥15 mmol/L. We estimate that the number needed to detect a possible new case of diabetes falls from 16 (in‐hospital glucose 8 mmol/L to <9 mmol/L) to 4 (14 mmol/L to <15 mmol/L).
Conclusion
The number of people who need to be tested to identify an individual who may have diabetes decreases as a testing threshold based on maximum in‐hospital glucose concentration increases. Among those with hyperglycaemia and no previous HbA1c measurement in the diabetes range, there appears to be a lack of subsequent HbA1c measurement. This work identifies the potential for integrating the testing and follow‐up of people, with apparently unrecognised hospital hyperglycaemia across primary and secondary care.</description><subject>Adult</subject><subject>Blood Glucose - analysis</subject><subject>Cohort analysis</subject><subject>cohort study</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus - diagnosis</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Female</subject><subject>Glucose</subject><subject>Glycated Hemoglobin - analysis</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>Hyperglycemia</subject><subject>Hyperglycemia - diagnosis</subject><subject>Hyperglycemia - epidemiology</subject><subject>Inpatient care</subject><subject>in‐hospital testing, diagnosis, digital health</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical tests</subject><subject>Retrospective Studies</subject><issn>0742-3071</issn><issn>1464-5491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp1kctu1TAQhi0EoofCghdAltjQRVo7zsVmh0q5SEVIqKwtJ56cuCRx8OWgs-sj8Ag8G0_ClFNYIOGNbfmbb8b6CXnK2SnHdWZnOOWV4vIe2fCqqYoaL_fJhrVVWQjW8iPyKMZrxniphHpIjkQthRKMb8iPqxHo6hMsyZmJDj7QnNzkolu21C0_b76PPq4u4dt2yr2PQGcwMQeYsSTS5KmFBH1C2Lqds9lMkZpER7cdaXDxC_UDXQPsnM9x2tOMmNkuKLIUTx0Wx5f0E6SAfdDjdkB7P_qQaEzZ7h-TBwMq4cndfkw-v7m4On9XXH58-_781WXRCyllIaWSBkwrWyMkHyoQRklbGxBNZ4RSnHWqacrODp3ohqFRTPV9w4Sp2rauOiaOyYuDdw3-a4aY9OxiD9NkFsDJddmgo1Jte4s-_we99jksOJ0uWy6YlHXJkTo5UD3-LAYY9BrcbMJec6ZvY9MYm_4dG7LP7oy5m8H-Jf_khMDZAfjmJtj_36Rff7g4KH8BYj6mNg</recordid><startdate>202210</startdate><enddate>202210</enddate><creator>Farmer, Andrew J.</creator><creator>Shine, Brian</creator><creator>Armitage, Laura C.</creator><creator>Murphy, Noel</creator><creator>James, Tim</creator><creator>Guha, Nishan</creator><creator>Rea, Rustam</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6170-4402</orcidid><orcidid>https://orcid.org/0000-0001-6515-8325</orcidid></search><sort><creationdate>202210</creationdate><title>The potential for utilising in‐hospital glucose measurements to detect individuals at high risk of previously undiagnosed diabetes: Retrospective cohort study</title><author>Farmer, Andrew J. ; Shine, Brian ; Armitage, Laura C. ; Murphy, Noel ; James, Tim ; Guha, Nishan ; Rea, Rustam</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3888-8898aea787a381f4e3a98d5ae36ba39910b9662bdfb3bff6909cc603a47754b03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult</topic><topic>Blood Glucose - analysis</topic><topic>Cohort analysis</topic><topic>cohort study</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetes Mellitus - diagnosis</topic><topic>Diabetes Mellitus - epidemiology</topic><topic>Female</topic><topic>Glucose</topic><topic>Glycated Hemoglobin - analysis</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Hyperglycemia</topic><topic>Hyperglycemia - diagnosis</topic><topic>Hyperglycemia - epidemiology</topic><topic>Inpatient care</topic><topic>in‐hospital testing, diagnosis, digital health</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Medical tests</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Farmer, Andrew J.</creatorcontrib><creatorcontrib>Shine, Brian</creatorcontrib><creatorcontrib>Armitage, Laura C.</creatorcontrib><creatorcontrib>Murphy, Noel</creatorcontrib><creatorcontrib>James, Tim</creatorcontrib><creatorcontrib>Guha, Nishan</creatorcontrib><creatorcontrib>Rea, Rustam</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetic medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Farmer, Andrew J.</au><au>Shine, Brian</au><au>Armitage, Laura C.</au><au>Murphy, Noel</au><au>James, Tim</au><au>Guha, Nishan</au><au>Rea, Rustam</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The potential for utilising in‐hospital glucose measurements to detect individuals at high risk of previously undiagnosed diabetes: Retrospective cohort study</atitle><jtitle>Diabetic medicine</jtitle><addtitle>Diabet Med</addtitle><date>2022-10</date><risdate>2022</risdate><volume>39</volume><issue>10</issue><spage>e14918</spage><epage>n/a</epage><pages>e14918-n/a</pages><issn>0742-3071</issn><eissn>1464-5491</eissn><abstract>Background
Many people with undiagnosed diabetes have hyperglycaemia when admitted to hospital. Inpatient hyperglycaemia can be an indication of diabetes mellitus but can also indicate a stress response. This study reports the extent to which an in‐hospital maximum observed random glucose measurement is an indicator of the need for in‐hospital (or subsequent) HbA1c measurement to look for undiagnosed diabetes.
Methods
Blood glucose, HbA1c, age and sex were collected for all adults following admission to a UK NHS trust hospital from 1 January 2019 to 31 December 2020. We restricted the analysis to those participants who were registered with a GP practice that uses the trust laboratory and who had at least some tests requested by those practices since 2008. We stratified individuals according to their maximum in‐hospital glucose measurement and report the number of these with HbA1c measurement ≥48 mmol/mol (6.5%) prior to the index admission, and during and after admission. We calculated an estimated proportion of individuals in each blood glucose stratum without a follow‐up HbA1c who could have undiagnosed diabetes.
Results
In toal, 764,241 glucose measurements were recorded for 81,763 individuals who were admitted to the Oxford University Hospitals Trust. The median (Q1, Q3) age was 70 (56, 81) years, and 53% were males. Of the population, 70.7% of individuals declared themselves to be of White ethnicity, 3.1% of Asian background, and 1.1% of Black background, with 23.1% unstated. Of those individuals, 22,375 (27.4%) had no previous HbA1c measurement recorded. A total of 1689 individuals had a diabetes‐range HbA1c during or after their hospital admission (2.5%) while we estimate an additional 1496 (2.2%) may have undiagnosed diabetes, with the greatest proportion of these having an in‐hospital glucose of ≥15 mmol/L. We estimate that the number needed to detect a possible new case of diabetes falls from 16 (in‐hospital glucose 8 mmol/L to <9 mmol/L) to 4 (14 mmol/L to <15 mmol/L).
Conclusion
The number of people who need to be tested to identify an individual who may have diabetes decreases as a testing threshold based on maximum in‐hospital glucose concentration increases. Among those with hyperglycaemia and no previous HbA1c measurement in the diabetes range, there appears to be a lack of subsequent HbA1c measurement. This work identifies the potential for integrating the testing and follow‐up of people, with apparently unrecognised hospital hyperglycaemia across primary and secondary care.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>35839301</pmid><doi>10.1111/dme.14918</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-6170-4402</orcidid><orcidid>https://orcid.org/0000-0001-6515-8325</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Diabetic medicine, 2022-10, Vol.39 (10), p.e14918-n/a |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Blood Glucose - analysis Cohort analysis cohort study Diabetes Diabetes mellitus Diabetes Mellitus - diagnosis Diabetes Mellitus - epidemiology Female Glucose Glycated Hemoglobin - analysis Hospitals, University Humans Hyperglycemia Hyperglycemia - diagnosis Hyperglycemia - epidemiology Inpatient care in‐hospital testing, diagnosis, digital health Male Medical diagnosis Medical tests Retrospective Studies |
| title | The potential for utilising in‐hospital glucose measurements to detect individuals at high risk of previously undiagnosed diabetes: Retrospective cohort study |
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