The impact of acute illness on HbA1c Determination of Undiagnosed Diabetes
Diabetes/Metabolism Research and Reviews,  Clinical Article

Thakker U et al. – The HbA1c value is not substantially affected by acute illness and is feasible as a screening assay for diabetes in the acute care setting such as an ED.

Methods
  • Adult patients with no known history of diabetes were tested for HbA1c during an ED and scheduled follow–up visit. HbA1c differences between the two visits were compared using limits of agreement (LOA) with 95% confidence intervals.
  • The frequency of individuals who changed diagnostic categories (using > 6.5% to classify newly diagnosed diabetes) from ED to follow–up was determined.

Results
  • 589 patients were included with a mean age of 50 years and 57/589 (9.7%) had an ED HbA1c ≥6.5% with the average follow–up visit 45 days after the ED visit.
  • The mean ED HbA1c was 5.67% (±0.86) and the follow–up HbA1c was 5.65% (±0.89), (difference–0.0129%, 95% LOA –0.740, 0.714).
  • The ED and follow–up Hba1c was highly correlated (r² = 0.829).
  • While on follow–up almost all patients were classified in the same diagnostic category as in the ED, 17 patients had a HbA1c ≥6.5% in the ED and a HbA1c <6.5% on follow–up; most (14/17) still fell in an abnormal range (6.0–6.5%).

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