Routine glucose assessment in the emergency department for detecting unrecognised diabetes: a cluster randomised trial
| Autor: | Robert G. Moses, Debbie Scadden, Vincent W. Wong, Roger Chen, Patrick McElduff, Bernard L. Champion, Shamasunder Acharya, Sandy Middleton, David Chipps, Mary Webber, Jen M. Kinsella, Margaret Layton, Katherine T. Tonks, Jeff R. Flack, Carol A. Pollock, Lesley V. Campbell, N. Wah Cheung, Christopher J. White, Mark McLean, Gregory R. Fulcher, Ann M. Poynten, Barbara Depczynski, Kris Park, John P. Carter |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Blood Glucose Male Emergency Medical Services medicine.medical_specialty diagnosis Type 2 diabetes Disease cluster 03 medical and health sciences 0302 clinical medicine Diabetes mellitus medicine Humans 030212 general & internal medicine Aged Aged 80 and over Diagnostic Tests Routine business.industry Mortality rate General Medicine Odds ratio Emergency department Middle Aged medicine.disease health services research Hospital medicine Hospitalization hospital medicine Clinical trial Hyperglycemia diabetes mellitus Emergency medicine Female type 2 diabetes New South Wales business |
| Zdroj: | Medical Journal of Australia. 211:454-459 |
| ISSN: | 1326-5377 0025-729X |
| DOI: | 10.5694/mja2.50394 |
| Popis: | Objective To determine whether routine blood glucose assessment of patients admitted to hospital from emergency departments (EDs) results in higher rates of new diagnoses of diabetes and documentation of follow-up plans. Design, setting Cluster randomised trial in 18 New South Wales public district and tertiary hospitals, 31 May 2011 - 31 December 2012; outcomes follow-up to 31 March 2016. Participants Patients aged 18 years or more admitted to hospital from EDs. Intervention Routine blood glucose assessment at control and intervention hospitals; automatic requests for glycated haemoglobin (HbA1c ) assessment and notification of diabetes services about patients at intervention hospitals with blood glucose levels of 14 mmol/L or more. Main outcome measure New diagnoses of diabetes and documented follow-up plans for patients with admission blood glucose levels of 14 mmol/L or more. Results Blood glucose was measured in 133 837 patients admitted to hospital from an ED. The numbers of new diabetes diagnoses with documented follow-up plans for patients with blood glucose levels of 14 mmol/L or more were similar in intervention (83/506 patients, 16%) and control hospitals (73/278, 26%; adjusted odds ratio [aOR], 0.83; 95% CI 0.42-1.7; P = 0.61), as were new diabetes diagnoses with or without plans (intervention, 157/506, 31%; control, 86/278, 31%; aOR, 1.51; 95% CI, 0.83-2.80; P = 0.18). 30-day re-admission (31% v 22%; aOR, 1.34; 95% CI, 0.86-2.09; P = 0.21) and post-hospital mortality rates (24% v 22%; aOR, 1.07; 95% CI, 0.74-1.55; P = 0.72) were also similar for patients in intervention and control hospitals. Conclusion Glucose and HbA1c screening of patients admitted to hospital from EDs does not alone increase detection of previously unidentified diabetes. Adequate resourcing and effective management pathways for patients with newly detected hyperglycaemia and diabetes are needed. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12611001007921. |
| Databáze: | OpenAIRE |
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