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Cited by 43Diabetes Management and ResearchDiabetes, Cardiovascular Risks, and LipoproteinsDiabetes Treatment and Management

Inpatient HbA1c testing: a prospective observational study

Open access
Nanayakkara, Natalie, Nguyen, Hang, Churilov, Leonid, Kong, Alvin, Pang, Nyuk, Hart, Graeme K, Owen-Jones, Elizabeth, White, Jennifer +10 more·2015·BMJ Open Diabetes Research & Care
DOI 10.1136/bmjdrc-2015-000113PMC PMC4567658
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Abstract

Objective: To use admission inpatient glycated hemoglobin (HbA1c) testing to help investigate the prevalence of unrecognized diabetes, the cumulative prevalence of unrecognized and known diabetes, and the prevalence of poor glycemic control in both. Moreover, we aimed to determine the 6-month outcomes for these patients. Finally, we aimed to assess the independent association of diabetes with these outcomes. Research, design, and methods: Prospective observational cohort study conducted in a tertiary hospital in Melbourne, Australia. Patients: A cohort of 5082 inpatients ≥54 years admitted between July 2013 and January 2014 underwent HbA1c measurement. A previous diagnosis of diabetes was obtained from the hospital medical record. Patient follow-up was extended to 6 months. Results: The prevalence of diabetes (known and unrecognized) was 34%. In particular, we identified that unrecognized but HbA1c-confirmed diabetes in 271 (5%, 95% CI 4.7% to 6.0%) patients, previously known diabetes in 1452 (29%, 95% CI 27.3% to 29.8%) patients; no diabetes in 3359 (66%, 95% CI 64.8–67.4%) patients. Overall 17% (95% CI 15.3% to 18.9%) of patients with an HbA1c of >6.5% had an HbA1c ≥8.5%. After adjusting for age, gender, Charlson Index score, estimated glomerular filtration rate, and hemoglobin levels, with admission unit treated as a random effect, patients with previously known diabetes had lower 6-month mortality (OR 0.69, 95% CI 0.56 to 0.87, p=0.001). However, there were no significant differences in proportions of intensive care unit admission, mechanical ventilation or readmission within 6 months between the 3 groups. Conclusions: Approximately one-third of all inpatients ≥54 years of age admitted to hospital have diabetes of which about 1 in 6 was previously unrecognized. Moreover, poor glycemic control was common. Proportions of intensive care unit admission, mechanical ventilation, or readmission were similar between the groups. Finally, diabetes was independently associated with lower 6-month mortality.

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  • Inpatient treatment and discharge planning are more effective when preadmission glycemia is considered.

    “because inpatient treatment and discharge planning are more effective when preadmission glycemia is considered”

    From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [5]

    The Methods (page not provided) describe using admission HbA1c results to intensify treatment, plan further management, and inform discharge summaries. That supports considering glycemic status in care planning, but the paper does not show that doing so makes treatment or discharge planning more effective. The Conclusions say the impact on patient outcomes requires further study. (LLM, conf=0.87)

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Authors
Nanayakkara, N., Nguyen, H., Churilov, L., Kong, A., Pang, N., Hart, G. K., Owen-Jones, E., White, J., Ross, J., Stevenson, V., Bellomo, R., Lam, Q., Crinis, N., Robbins, R., Johnson, D., Baker, S. T., Zajac, J. D., & Ekinci, E. I.
Affiliations
  • Austin Hospital (AU)
  • Florey Institute of Neuroscience and Mental Health (AU)
  • The University of Melbourne (AU)
Corresponding author
Ekinci, Elif I
ORCID
Venue
BMJ Open Diabetes Research & Care
Publisher
BMJ
Published
2015-09
Volume
3
Issue
1
Pages
e000113
ISSN
2052-4897 (ISSN-L)
DOI
10.1136/bmjdrc-2015-000113
PMC
PMC4567658
OpenAlex
W2287953383
Cited by
43
References
3
Citations by year
2026: 2 · 2025: 3 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 5 · 2020: 3 · 2019: 8 · 2018: 4 · 2017: 6 · 2016: 3
FWCI
3.77
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Open Diabetes Research & Care (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
HbA1c, undiagnosed diabetes, diabetes prevalence, poor glycemic control, hospitalized patients, hospitalization, 6-month mortality, intensive care unit admission, mechanical ventilation, hospital readmission, older adults

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