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Diabetes Screening in A&E Could Detect Thousands of Undiagnosed Cases

Emergency department screening could detect thousands of undiagnosed prediabetes and diabetes cases, according to results of a UK study.

There are more than 4.3 million people in the UK with diabetes but around 850,000 are yet to be diagnosed, according to figures from Diabetes UK. "Early diagnosis is the best way to avoid the devastating complications of type 2 diabetes and offers the best chance of living a long and healthy life", emphasised Professor Edward Jude, of Tameside and Glossop Integrated Care NHS Foundation Trust, who led the investigation. 

Diabetes and Pre-diabetes Identified in Around 4 out of 10 Screened

For the study, presented at this year's annual meeting of The European Association for the Study of Diabetes in Hamburg, researchers set out to screen people not known to have diabetes who attended A&E departments. They included 1388 randomly selected patients visiting the A&E department at the Trust. All the patients were without a diabetes diagnosis when they attended.

Of the patients screened:

  • 61% had normal blood glucose levels – average age 51 years, average HbA1c 34 mmol/mol, average weight 81kg, and average BMI 28.4 kg/m²
  • 9% of patients were found to have type 2 diabetes – a similar proportion in men and women, average age 56 years, average HbA1c 51 mmol/mol, average weight 94kg, and average BMI 31.2 kg/m²
  • 30% were found to have prediabetes – average age 57 years, average HbA1c 41 mmol/mol, average weight 82kg, and average BMI 28.6 kg/m²

The researchers also found that people of South Asian and other ethnic backgrounds had a higher incidence of glucose intolerance compared to Caucasians — 42.65% vs 37.8% — and were twice as likely to be diagnosed with pre-diabetes or diabetes.

Tens of Thousands of New Diabetes and Pre-diabetes Cases Could Be Diagnosed in A&E

Patients were also asked to complete a questionnaire about demographics, ethnicity, and risk factors for diabetes, with the information used to calculate each patient's Finnish Diabetes Risk Score (FINDRISC) to identify those at risk of developing type 2 diabetes. Scores of more than 20 indicated a very high risk of developing diabetes — 50% chance over 10 years — and scores of 12 to 20 indicated moderate to high risk – 33% chance over 10 years.

The researchers identified that for each unit increase in the FINDRISC score above zero, there was an associated 7% increased risk for prediabetes and a 16 % increased risk for type 2 diabetes, after adjusting for age and sex.

Based on the results, "tens of thousands" of new cases of prediabetes and diabetes could be diagnosed in A&E departments across the country every year, according to the authors.

They did, however, acknowledge some limitations to the study, which included that it was conducted at a single hospital, which meant the results "may not be generalisable" to other hospitals across England, they pointed out.

Screening Would Target People Who Do Not Routinely Access Healthcare

"Individuals attending A&E have a high incidence of unknown glucose intolerance," underlined the authors, who recommended that patients admitted to hospital should be screened for diabetes using the HbA1c test. 

"Opportunistic HbA1c-based screening in A&E departments, particularly those in high-risk and hard to reach groups, could make an important contribution to identifying undiagnosed individuals who will benefit from early treatment and lifestyle changes and so reduce their risks of long-term complications", Professor Jude said. "Our findings suggest that the FINDRISC score could also be used to help ensure those at highest risk of developing type 2 diabetes are made aware of their risk," he added.

Asked to comment for Medscape News UK, Esther Walden, deputy head of care at Diabetes UK, said that the study suggested "opportunistic screening in A&E" could detect some of the estimated 850,000 cases of undiagnosed type 2 diabetes in the UK. "This could particularly help diagnose people who don't routinely access healthcare, potentially helping to reduce inequalities in diabetes care," she stressed.

Any Screening Programme "Must Be Properly Funded"

However, those who would be responsible for the screening were more cautious about the idea. Commenting for Medscape News UK, Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said that before a screening program was instituted in any emergency department "we need to understand the cost benefit and be assured that the associated additional work is resourced and funded properly".

He pointed out that emergency medicine clinicians were "frequently asked" to implement screening programs for many diseases – for example, alcohol misuse, HIV, and hypertension. "We worry that prioritising any one disease could lead to a de-prioritisation of another," he alerted. 

"The primary function of an emergency department is to provide time critical emergency care to acute undifferentiated emergencies. Anything that detracts from that core function is a lower priority," Dr Boyle added.

The research has been peer reviewed by the congress selection committee, but there is no full paper at this stage.

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Editor's note: This article was updated on 5 October to include comments by Dr Adrian Boyle, president of the Royal College of Emergency Medicine.