LBSUN211 The Importance Of Early Opportunities To Identify And Treat Prediabetes Or Even Change The Diagnostic Threshold For Diabetes

Abstract

Abstract Introduction 34.5% of US adults meet criteria for prediabetes, while 13% of US adults have diabetes. Diabetes increases the risk for many serious conditions. Recommendations for early screening and management of prediabetes have recently been updated. Hypothesis Diabetes has been associated with higher frequency use of emergency department (ED) services and inpatient admission, leading to higher costs associated with diabetes. We compare patients with diabetes or prediabetes for use of ED and inpatient care hypothesizing that prediabetic patients will have fewer visits to the ED and hospital. We additionally described differences in characteristics between these two groups to identify health inequities. Research Design: Data on people with Type 2 diabetes (DM) or prediabetes (PD) who seen in the ED March 2018 and December 2019 were extracted from an EHR. Descriptive statistics were compared between people with DM and PD using t-test or chi square tests. Linear and logistic regression analyses were conducted to compare DM to PD frequency of ED visits, high utilization of ED (3+ ED visits per year), admission to inpatient care. A p-value of 0. 05 or less is considered significant. Major Results PD patients were younger, and female compared to DM patients. Bivariate analysis show PD patients had fewer ED visits per year on average (1.2 v 1.5, (p<. 0001) compared to DM, and were less than half as likely to have 4+ visits per year (2. 0% v 5.4%, p <. 0001). Several comorbidities were examined, and all were significantly higher amongst DM patients. PD patients were more likely to have 0 or 1 comorbidities (69.6% vs. 55.3%, p <. 0001) compared to DM. In the linear regression analysis, PD was negatively associated with ED visits (-0.2 (-0.3, -0.1, p <. 0001) after adjusting for age, gender, race, and poverty, as well as multiple comorbidities. Similar findings emerged in a logistic regression analysis of high ED utilization, and linear regression analysis of inpatient admission. Interpretation of Results and Conclusions Our data suggest that adverse outcomes of hyperglycemia accrue prior to current HgA1c cut-off for the diagnosis of diabetes, deserve therapy, and even changing the threshold of diagnosis of diabetes to HgA1c= 5.7. Considering previously reported costs associated with ED visits (averaging $2200 per visit nationally) and inpatient care, early management of prediabetes represents an important health economic priority. Management of PD offers an opportunity to improve outcomes and reduce morbidity and early mortality associated with DM. Our study found that PD was associated with fewer ED visits, fewer debilitating comorbidities such as retinopathy, COPD, CKD, and CHF. PD patients were less likely to have any comorbidities in comparison to DM patients. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.