Abstract
Early identification/diagnosis of diabetes and frequent monitoring of hyperglycemia reduces hospitalizations and diabetes-related complications. The present study investigated the proportion of older adults coded with diabetes or newly diagnosed during their admissions and assessed discharge summary content for diabetes-related information. The study used electronic data on 4796 individuals aged ≥60 years admitted through the emergency department (ED) of a public hospital from 2017 to 2018 extracted using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM code). The proportion of admitted patients who were diagnosed with diabetes over a one-year period, proportion with glycated hemoglobin A1c (HbA1c) and random blood glucose (RBG) test performed during their stay, length of stay, discharge summary information and the factors associated with elevated HbA1c (>7%/53 mmol/mol) were investigated. In total, 8.6% of ED presentations to the hospital were coded with diabetes, excluding gestational consisting of 879 patients (449 males, 430 females) aged ≥ 60 years (74.6 ± 8.9 years). In total, 98% had type 2 diabetes (n = 863), 53% were Australian-born (n = 467), and the mean body mass index (BMI, 31 ± 7 kg/m2; n = 499, 56.8%), RBG (9.8 ± 5.2 mmol/L; n = 824, 93.7%) and HbA1c (8.0 ± 2.0%; n = 137, 15.6%) and length of stay (6.7 ± 25.4 days) were similar between gender, age, and nationality (p > 0.05). Three coded patients (0.3%) were newly diagnosed during the admission. In total, 86% had elevated HbA1c, but this was recorded in 20% of discharge summaries. Patients who are on a combination therapy (adjusted odds ratio 23%, 95% confidence intervals: 7%/38%), those on SGLT2 Inhibitors (aOR, 14%: 2%/26%) or had a change in medication (aOR, 40%: 22%/59%) had lower odds of having elevated HbA1c during admission. The low diagnosis rate of diabetes and the lack of clinical assessment of HbA1c in older adults admitted through the ED of a South Western Sydney public hospital suggest that many patients with diabetes either remain undiagnosed even during admission and/or are going to the ED with unknown diabetes that is unidentified with current practices. The clinically important HbA1c results were only infrequently communicated with general practitioners (GPs).
Highlights
Diabetes is a significant health problem globally [1], in Australia [2] and in the South WesternSydney (SWS) region [3], resulting in significant morbidity and mortality [4]
hemoglobin A1c (HbA1c) in older adults admitted through the emergency department (ED) of a South Western Sydney public hospital suggest that many patients with diabetes either remain undiagnosed even during admission and/or are going to the ED with unknown diabetes that is unidentified with current practices
The main findings of this study were the low diagnosis rate of diabetes (0.3%) in the admitted patients coded with diabetes, over a one-year period, the low communication rate between the hospitals and the general providers, and the very low uptake of glucose monitoring using HbA1c test, even in those with diabetes-related complications/comorbidities, despite the high prevalence of diabetes in this age group [8] and in the South WesternSydney (SWS) region [25]
Summary
Diabetes is a significant health problem globally [1], in Australia [2] and in the South WesternSydney (SWS) region [3], resulting in significant morbidity and mortality [4]. Diabetes is a significant health problem globally [1], in Australia [2] and in the South Western. In 2017, there were approximately 1.3 million adults living in Australia with known diabetes, with the number reaching well over 1.7 million including those with undiagnosed diabetes [2]. In SWS, the number of people with diabetes (all types) has increased by over 158% since 2000 [3] exceeding that of the state and national averages [3,5]. According to a recent monograph, approximately 60.9% of people with diabetes in SWS were aged 60 years and over [8]. Evidence indicates that diabetes in older adults is linked to higher mortality, reduced functional status, and increased risk of hospitalization [9]
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