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Screening program for undiagnosed diabetes

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Dr Varun Arora, Professor, Dept. of Community Medicine, Pt BDS PGIMS, Rohtak, India; and Dr Sanjay Kalra, DM (AIIMS); President-elect, SAFES, Bharti Hospital, Karnal, India    28 January 2023

An electronic medical record (EMR) based screening program in the Emergency Department (ED) was able to detect patients with undiagnosed prediabetes and diabetes, according to a single-center pilot study published in JAMA Network Open.

 

This study was conducted at the Dept. of Emergency Medicine, University of Illinois in Chicago and involved 8441 patients visiting the ED from February through to April 2021. The hospital EMR had an in-built best practice alert that picked out patients at risk for type 2 diabetes based on the recommendations of the American Diabetes Association (ADA): aged ≥45 years or patients aged 18-44 years with BMI ≥25 kg/m2, no known history of diabetes and those who had not been tested for A1c test in the preceding 3 years. The most common reason for visiting the ED related to heart problems.

 

Out of the 8441 patients included in the study, 2567 were tested for type 2 diabetes following an alert by the EMR. Of these, 2074 underwent tests for A1c and more than half (52.3%) had an abnormal result (≥5.7%). Nearly 70% (758) had prediabetes (5.7-6.4%) and 30% (327) were found to have diabetes (≥6.5%). Among those who were diabetic, 62 had severe diabetes with A1c of ≥10%. The researchers contacted 352 patients, mean age 52 years, with high A1c by telephone. Half of them had public insurance and 54.5% were women. “The median income of those contacted was in the 44th percentile of the US income”. Eighty-eight (25%) patients had been diagnosed with prediabetes or type 2 diabetes, but only 51 (58%) were taking treatment, while the remaining 264 patients were unaware of their diabetic status.

 

As per the International Diabetes Federation (IDF), in 2021, around 537 million adults (20-79 years) are living with diabetes and an estimated 1 in 2 (240 million) adults living with diabetes remain undiagnosed. Over 3 in 4 adults with diabetes reside in low- and middle-income countries.

 

These findings show that the ED screening program installed in the EMR system was able to identify a large number of patients visiting the ED, with previously undiagnosed prediabetes or type 2 diabetes. Most of them belonged to the low-income group. The system was also able to identify patients who were not taking treatment for their diabetes indicative of poorly-controlled diabetes.

 

This study exemplifies how technology can come to the aid of the clinician. It also highlights the need to strengthen the healthcare system to improve access to diabetes screening programs as well as timely and appropriate diabetes care. Because by the time the condition is diagnosed, many would already have developed the microvascular and/or macrovascular complications of diabetes. The authors however recommend further study to determine the feasibility of such a screening program in day-to-day practice.

 

Reference

 

  1. Kirstie K Danielson, et al. Prevalence of undiagnosed diabetes identified by a novel electronic medical record diabetes screening program in an urban emergency department in the US. JAMA Netw Open. 2023;6(1):e2253275. doi: 10.1001/jamanetworkopen.2022.53275.

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