Do Hospital Doctors Screen for Diabetes?

Background: One in five hospitalized patients presents with previously undetected diabetes mellitus (DM). We assessed whether hospital doctors measure HbAc in hospitalized patients and act consequently.

Methods: Data from patients hospitalized between January 2013 and December 2014 in a Swiss teaching hospital was collected. We assessed the frequency of HbA1c measurements and the number of newly detected prediabetes or DM. We also examined whether HbA1c values were associated with the antidiabetic drugs prescription and reporting of DM in the discharge letter.

Results: Of the 2618 patients studied, 298 (11.4%) had HbAc measured, of whom 136 (45.6%) had no previous history of DM. Of the 136 patients without history of DM, 51 (37.5%) had prediabetic state and 23 (16.9%) had DM. Newly detected prediabetes or DM were reported in 5.8% (3/51) and 65.8% of cases (15/23), respectively. Only half of patients (11/23, 47.8%) with newly detected DM received antidiabetic drug treatment at discharge. Patients with newly detected DM (n=23) had a longer length of stay (median and interquartile range: 16 [9-25] versus 10 [8-16] days, p=0.028) compared to patients without DM, while no such differences were found regarding in-hospital mortality.

Conclusions: Hospital doctors seldom prescribe HbA1c measurement in medical hospitalized patients. Prescription of HbAc measurement leads to a high detection rate (53%) of (pre)DM among patients unaware of their status, but management and reporting of these conditions at discharge could be further improved.