Inpatient Glucose Values: Determining the Nondiabetic Range and Use in Identifying Patients at High Risk for Diabetes

Mary K. Rhee, Sandra E. Safo, Sandra L. Jackson, Wenqiong Xue, Darin E. Olson, Qi Long, Diana Barb, J. Sonya Haw, Anne M. Tomolo, Lawrence S. Phillips

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Many individuals with diabetes remain undiagnosed, leading to delays in treatment and higher risk for subsequent diabetes complications. Despite recommendations for diabetes screening in high-risk groups, the optimal approach is not known. We evaluated the utility of inpatient glucose levels as an opportunistic screening tool for identifying patients at high risk for diabetes. Methods: We retrospectively examined 462,421 patients in the US Department of Veterans Affairs healthcare system, hospitalized on medical/surgical services in 2000-2010, for ≥3 days, with ≥2 inpatient random plasma glucose (RPG) measurements. All had continuity of care: ≥1 primary care visit and ≥1 glucose measurement within 2 years before hospitalization and yearly for ≥3 years after discharge. Glucose levels during hospitalization and incidence of diabetes within 3 years after discharge in patients without diabetes were evaluated. Results: Patients had a mean age of 65.0 years, body mass index of 29.9 kg/m2, and were 96% male, 71% white, and 18% black. Pre-existing diabetes was present in 39.4%, 1.3% were diagnosed during hospitalization, 8.1% were diagnosed 5 years after discharge, and 51.3% were never diagnosed (NonDM). The NonDM group had the lowest mean hospital RPG value (112 mg/dL [6.2 mmol/L]). Having at least 2 RPG values >140 mg/dL (>7.8 mmol/L), the 95th percentile of NonDM hospital glucose, provided 81% specificity for identifying incident diabetes within 3 years after discharge. Conclusions: Screening for diabetes could be considered in patients with at least 2 hospital glucose values at/above the 95th percentile of the nondiabetic range (141 mg/dL [7.8 mmol/L]).

Original languageEnglish (US)
Pages (from-to)443.e11-443.e24
JournalAmerican Journal of Medicine
Volume131
Issue number4
DOIs
StatePublished - Apr 2018

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Inpatients
Glucose
Hospitalization
United States Department of Veterans Affairs
Continuity of Patient Care
Patient Discharge
Diabetes Complications
Primary Health Care
Body Mass Index
Delivery of Health Care
Incidence

Keywords

  • Diabetes mellitus
  • Epidemiology
  • Screening

Cite this

Inpatient Glucose Values : Determining the Nondiabetic Range and Use in Identifying Patients at High Risk for Diabetes. / Rhee, Mary K.; Safo, Sandra E.; Jackson, Sandra L.; Xue, Wenqiong; Olson, Darin E.; Long, Qi; Barb, Diana; Haw, J. Sonya; Tomolo, Anne M.; Phillips, Lawrence S.

In: American Journal of Medicine, Vol. 131, No. 4, 04.2018, p. 443.e11-443.e24.

Research output: Contribution to journalArticle

Rhee, MK, Safo, SE, Jackson, SL, Xue, W, Olson, DE, Long, Q, Barb, D, Haw, JS, Tomolo, AM & Phillips, LS 2018, 'Inpatient Glucose Values: Determining the Nondiabetic Range and Use in Identifying Patients at High Risk for Diabetes', American Journal of Medicine, vol. 131, no. 4, pp. 443.e11-443.e24. https://doi.org/10.1016/j.amjmed.2017.09.021
Rhee, Mary K. ; Safo, Sandra E. ; Jackson, Sandra L. ; Xue, Wenqiong ; Olson, Darin E. ; Long, Qi ; Barb, Diana ; Haw, J. Sonya ; Tomolo, Anne M. ; Phillips, Lawrence S. / Inpatient Glucose Values : Determining the Nondiabetic Range and Use in Identifying Patients at High Risk for Diabetes. In: American Journal of Medicine. 2018 ; Vol. 131, No. 4. pp. 443.e11-443.e24.
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abstract = "Background: Many individuals with diabetes remain undiagnosed, leading to delays in treatment and higher risk for subsequent diabetes complications. Despite recommendations for diabetes screening in high-risk groups, the optimal approach is not known. We evaluated the utility of inpatient glucose levels as an opportunistic screening tool for identifying patients at high risk for diabetes. Methods: We retrospectively examined 462,421 patients in the US Department of Veterans Affairs healthcare system, hospitalized on medical/surgical services in 2000-2010, for ≥3 days, with ≥2 inpatient random plasma glucose (RPG) measurements. All had continuity of care: ≥1 primary care visit and ≥1 glucose measurement within 2 years before hospitalization and yearly for ≥3 years after discharge. Glucose levels during hospitalization and incidence of diabetes within 3 years after discharge in patients without diabetes were evaluated. Results: Patients had a mean age of 65.0 years, body mass index of 29.9 kg/m2, and were 96{\%} male, 71{\%} white, and 18{\%} black. Pre-existing diabetes was present in 39.4{\%}, 1.3{\%} were diagnosed during hospitalization, 8.1{\%} were diagnosed 5 years after discharge, and 51.3{\%} were never diagnosed (NonDM). The NonDM group had the lowest mean hospital RPG value (112 mg/dL [6.2 mmol/L]). Having at least 2 RPG values >140 mg/dL (>7.8 mmol/L), the 95th percentile of NonDM hospital glucose, provided 81{\%} specificity for identifying incident diabetes within 3 years after discharge. Conclusions: Screening for diabetes could be considered in patients with at least 2 hospital glucose values at/above the 95th percentile of the nondiabetic range (141 mg/dL [7.8 mmol/L]).",
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T2 - Determining the Nondiabetic Range and Use in Identifying Patients at High Risk for Diabetes

AU - Rhee, Mary K.

AU - Safo, Sandra E.

AU - Jackson, Sandra L.

AU - Xue, Wenqiong

AU - Olson, Darin E.

AU - Long, Qi

AU - Barb, Diana

AU - Haw, J. Sonya

AU - Tomolo, Anne M.

AU - Phillips, Lawrence S.

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Y1 - 2018/4

N2 - Background: Many individuals with diabetes remain undiagnosed, leading to delays in treatment and higher risk for subsequent diabetes complications. Despite recommendations for diabetes screening in high-risk groups, the optimal approach is not known. We evaluated the utility of inpatient glucose levels as an opportunistic screening tool for identifying patients at high risk for diabetes. Methods: We retrospectively examined 462,421 patients in the US Department of Veterans Affairs healthcare system, hospitalized on medical/surgical services in 2000-2010, for ≥3 days, with ≥2 inpatient random plasma glucose (RPG) measurements. All had continuity of care: ≥1 primary care visit and ≥1 glucose measurement within 2 years before hospitalization and yearly for ≥3 years after discharge. Glucose levels during hospitalization and incidence of diabetes within 3 years after discharge in patients without diabetes were evaluated. Results: Patients had a mean age of 65.0 years, body mass index of 29.9 kg/m2, and were 96% male, 71% white, and 18% black. Pre-existing diabetes was present in 39.4%, 1.3% were diagnosed during hospitalization, 8.1% were diagnosed 5 years after discharge, and 51.3% were never diagnosed (NonDM). The NonDM group had the lowest mean hospital RPG value (112 mg/dL [6.2 mmol/L]). Having at least 2 RPG values >140 mg/dL (>7.8 mmol/L), the 95th percentile of NonDM hospital glucose, provided 81% specificity for identifying incident diabetes within 3 years after discharge. Conclusions: Screening for diabetes could be considered in patients with at least 2 hospital glucose values at/above the 95th percentile of the nondiabetic range (141 mg/dL [7.8 mmol/L]).

AB - Background: Many individuals with diabetes remain undiagnosed, leading to delays in treatment and higher risk for subsequent diabetes complications. Despite recommendations for diabetes screening in high-risk groups, the optimal approach is not known. We evaluated the utility of inpatient glucose levels as an opportunistic screening tool for identifying patients at high risk for diabetes. Methods: We retrospectively examined 462,421 patients in the US Department of Veterans Affairs healthcare system, hospitalized on medical/surgical services in 2000-2010, for ≥3 days, with ≥2 inpatient random plasma glucose (RPG) measurements. All had continuity of care: ≥1 primary care visit and ≥1 glucose measurement within 2 years before hospitalization and yearly for ≥3 years after discharge. Glucose levels during hospitalization and incidence of diabetes within 3 years after discharge in patients without diabetes were evaluated. Results: Patients had a mean age of 65.0 years, body mass index of 29.9 kg/m2, and were 96% male, 71% white, and 18% black. Pre-existing diabetes was present in 39.4%, 1.3% were diagnosed during hospitalization, 8.1% were diagnosed 5 years after discharge, and 51.3% were never diagnosed (NonDM). The NonDM group had the lowest mean hospital RPG value (112 mg/dL [6.2 mmol/L]). Having at least 2 RPG values >140 mg/dL (>7.8 mmol/L), the 95th percentile of NonDM hospital glucose, provided 81% specificity for identifying incident diabetes within 3 years after discharge. Conclusions: Screening for diabetes could be considered in patients with at least 2 hospital glucose values at/above the 95th percentile of the nondiabetic range (141 mg/dL [7.8 mmol/L]).

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KW - Epidemiology

KW - Screening

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