Elevated capillary blood glucose in the emergency department suggests a higher probability of underlying diabetes or prediabetes

Abstract

Background: In the emergency department (ED), patients with no prior history of diabetes and with hyperglycemic capillary blood glucose (CBG) levels, an opportunity exists to detect undiagnosed diabetes. High glycosylated hemoglobin (HbA 1c ) levels in these patients could indicate underlying diabetes or prediabetes. Aim: To determine whether hyperglycemia in patients coming to ED without a history of diabetes is associated with elevated HbA 1c levels. Methods: A prospective correlational study of adults aged 18 years and more, presenting to ED with random CBG more than 140 mg/dL were enrolled. The patients with a history of diabetes were excluded. HbA 1c levels were checked in these patients and correlation was analyzed. Results: A total of 107 patients were enrolled and CBG levels were correlated with HbA 1c levels (r = 0.71, P < 0.0001). The median glucose and median HbA 1c levels were 201 mg/dL and 6.3%, respectively. The median time elapsed since last meal was 5 h (25-75% interquartile range, 4-9 h). Overall, 42.1% of the cases had elevated HbA 1c levels ≥6.5% while as 40.2% showed HbA 1c levels between 5.7% and 6.4%, which means 82.2% were either diabetic or prediabetic by HbA 1c criteria. Conclusion: CBG has a good correlation with HbA 1c . Therefore, in ED, HbA 1c should be considered in patients with CBG more than 140 mg/dL with no prior history of diabetes in order to uncover hidden diabetes/prediabetes and to exclude stress hyperglycemia.