Incidental Hyperglycemia and Detection of Diabetes in Patients Presenting to the Emergency Department of a Tertiary Care Hospital

Abstract

Introduction: Nearly half of people with diabetes don’t know they have it. It is often not diagnosed until complications appear. The aim of the study was to determine the prevalence of diabetes mellitus and prediabetes in patients presenting to the Emergency Department with incidental hyperglycemia, because the duration of hyperglycemia is a predictor of adverse outcomes, and there are effective interventions to prevent disease progression and to reduce complications.

Methods: It was an observational cross-sectional study, 720 patients from Emergency Department of Kathmandu Medical College, Sinamangal were screened from December 2018 to March 2019 and a total of 128 patients with incidental hyperglycemia (>140mg/dl) were included. Patients with a previous diagnosis of diabetes, unstable patients and pregnant patients were excluded. Incidental hyperglycemia, fasting blood sugar, 2 hours postprandial blood sugar and HbA1c were noted, data entry was done in Microsoft Excel and analysis was done using the SPSS 24.

Results: Total of 128 patients were enrolled for the study.10% of the patients had hyperglycemia and 34% among the hyperglycemic had the finding in the absence of history of diabetes. Incidental hyperglycemia ranged from 150-500 mg/dl. Among the incidental hyperglycemic, 29% and 36% had prediabetes and diabetes respectively. Incidental hyperglycemia was divided into four groups; <159, 160-179, 180-199 and >200 mg/dl, and each group was analyzed with the diagnostic criteria and the final outcome. It was found that each group correlated well with the diagnostic criteria and final outcome and was found to be statistically significant with p<0.0001 based on the Chi square test.

Conclusions: Following the patients with incidental hyperglycemia in the Emergency Department, a significant number of undiagnosed diabetes or prediabetes can be diagnosed, early intervention can be started that can prevent progression from prediabetes to diabetes and risk of complications can be reduced.