170-OR: Hyperglycemia in Patients without Diabetes in the Emergency Department and Subsequent Cascade of Care

Introduction: Hyperglycemia in patients without a history of diabetes (DM) is common in the Emergency Department (ED). Data describing how this is routinely managed is lacking. In this study, we report how often patients in the ED without a history of diabetes and hyperglycemia (blood glucose (BG) > 200 mg/dL) receive a HbA1c and diabetes education (DE).

Methods: This retrospective study evaluates patients in our ED with a random BG ≥ 200 mg/dL and no prior history of DM based on medical record review. In total, 110 charts were analyzed. These patients were divided into two groups: admitted for inpatient treatment (AD) and discharged from the ED (DCED). 90-day endpoints included: HbA1c performed and completion of DE. We also compared the frequency of diabetes diagnosis in these populations.

Results: Of the 110 patients studied, 62 (56%) were AD and 48 (44%) were DCED. Within 90 days from the ED visit, 40 (65%) of AD had an HbA1C performed compared to 18 (38%) of DCED. Of AD patients, 25 (63%) were diagnosed with DM based on HbA1c ≥ 6.5%, compared to 13 (72%) of those DCED. Of patients with a new diagnosis of DM, 22 (88%) of AD received DE, while only 4 (31%) of DCED patients received DE.

Conclusion: We have determined that patients with hyperglycemia without a history of DM in our ED are inadequately screened for DM. 53% of this population received HbA1c evaluations within 90 days. Of patients who had a HbA1c performed, 66% were diagnosed with diabetes. AD patients were approximately twice as likely as those DCED to have a HbA1c performed. AD patients with a diagnosis of diabetes were three times as likely to have met with a diabetes educator relative to those DCED. Hyperglycemia in our ED is an opportunity to diagnose DM that is currently underutilized.