HbA1c Identifies Diabetes, Prediabetes in Acute Care

Hemoglobin A1c (HbA1c) measurements can be used as a reliable screen for undiagnosed diabetes, prediabetes, and dysglycemia in emergency settings, according to a study published online July 20 in Diabetes Care.

Robert A. Silverman, M.D., from the Long Island Jewish Medical Center in New York, and colleagues, determined optimal HbA1c screening cut-offs for undiagnosed dysglycemia in emergency departments. A total of 618 adults aged 18 years and older with no prior history of hyperglycemia presenting to the emergency department with acute illness were included. Following recovery from acute illness, outpatient fasting blood sugar and two-hour oral glucose tolerance test (OGTT) were performed allowing diagnostic categorizations of prediabetes, diabetes, and dysglycemia, and determination of optimal cut-offs.

The investigators found that the prevalence of previously undiagnosed prediabetes and diabetes based on the OGTT was 31.9 and 10.5 percent, respectively. The optimal HbA1c screening cut-offs for prediabetes, diabetes, and dysglycemia were 5.7, 5.8, and 6.0 percent, respectively.

"Optimal HbA1c cut-off values for screening for prediabetes and diabetes in an acute-care setting are similar to cut-offs from populations tested in outpatient settings. There is potential to identify large numbers of emergency department patients with dysglycemia using HbA1c," the authors write.

Diabetes Care, Aug. 2011 online, July 20, 2011