Diabetes Case Finding Using HbA1c Testing

Western Sydney LHD conducted a pilot study on patients presenting to the Emergency Department (ED) at Blacktown Hospital to assess the efficacy of HbA1c testing to detect diabetes and pre-diabetes in an area of high diabetes prevalence.

Opportunistic blood glucose levels were measured in all non-pregnant individuals who had blood collected after presenting to the ED for any clinical indication. HbA1c was automatically measured if the random glucose level was ≥ 5.5mmol/L. Diabetes was diagnosed if the HbA1c was ≥ 6.5% and pre-diabetes if HbA1c was between 5.7-6.4%.

There were 4580 presentations to the ED and 1267 (27%) HbA1c measurements were obtained over the 6 week period. In this cohort:

  • Diabetes (HbA1c of ≥ 6.5%) was present in 38.4% (n=487)
  • Diabetes was newly diagnosed in 32.2% (n=157)

Pre-diabetes (HbA1c of 5.7-6.4%) was diagnosed in 27.4% (n=347)

  • Hospital coding analysis revealed 28% (n=88) of patients identified as having diabetes through ED HbA1c testing were not coded for a diagnosis of diabetes on discharge

Opportunistic testing for diabetes is effective as almost a third of individuals tested had undiagnosed diabetes. In addition, more than a quarter of individuals were at risk of developing diabetes. Early detection provides an opportunity to initiate preventative measures such as NSW Government's 'Get Healthy' program.

PHN Western Sydney PwC Diabetes NSW NSW Health