Expanding Diabetes Screening to Identify Undiagnosed Cases Among Emergency Department Patients.

Introduction

Diabetes screening traditionally occurs in primary care settings, but many who are at high risk face barriers to accessing care and therefore delays in diagnosis and treatment. These same high-risk patients do frequently visit emergency departments (ED) and, therefore, might benefit from screening at that time. Our objective in this study was to analyze one year of results from a multisite, ED-based diabetes screening program.

Methods

We assessed the demographics of patients screened, identified differences in rates of newly diagnosed diabetes by clinical site, and the geographic distribution of high and low hemoglobin A1c (HbA1c) results.

Results

We performed diabetes screening (HbA1c) among 4,211 ED patients 40-70 years old, with a body mass index ≥25, and no prior history of diabetes. Of these patients screened for diabetes, 9% had a HbA1c result consistent with undiagnosed diabetes, and nearly half of these patients had a HbA1c ≥9.0%. Rates of newly diagnosed diabetes were notably higher at EDs located in neighborhoods of lower socioeconomic status.

Conclusion

Emergency department-based diabetes screening may be a practical and scalable solution to screen high-risk patients and reduce health disparities experienced in specific neighborhoods and demographic groups.