Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2008 Nov;93(11):4238-44.
doi: 10.1210/jc.2008-1090. Epub 2008 Aug 12.

Prevalence of elevated hemoglobin A1c among patients admitted to the hospital without a diagnosis of diabetes

Deborah J Wexler  1 , David M Nathan, Richard W Grant, Susan Regan, Allison L Van Leuvan, Enrico Cagliero
Affiliations

Prevalence of elevated hemoglobin A1c among patients admitted to the hospital without a diagnosis of diabetes

Deborah J Wexler et al. J Clin Endocrinol Metab. 2008 Nov.

Abstract

Context: One in four hospitalized patients has diagnosed diabetes. The prevalence of unrecognized, or undiagnosed, diabetes among hospitalized patients is not well established.

Objective: Our objective was to determine the prevalence of unrecognized probable diabetes in this patient population determined by elevated hemoglobin A1c (HbA1c) level.

Design: We conducted a prospective observational cohort trial with retrospective follow-up of patients with elevated HbA1c levels and no diagnosis of diabetes. HbA1c levels were obtained for all patients.

Setting: The study was conducted at an acute care general hospital.

Patients: Patients included 695 adult, nonobstetric patients admitted on 11 d in 2006.

Main outcome measures: Outcome measures included rate of unrecognized probable diabetes, defined as admission HbA1c of more than 6.1% and no diagnosis of diabetes or treatment with antidiabetic medications before or during their admission and rate of unrecognized diabetes 1 yr after discharge.

Results: Eighteen percent of hospitalized patients had elevated HbA1c levels without a diagnosis of diabetes. Random glucose levels poorly predicted elevated HbA1c levels (area under receiver operating characteristic curve, 0.60). Neither diagnosed diabetes nor HbA1c level was associated with length of stay or costs (P>0.1 for all comparisons). Only 15% of patients with elevated HbA1c levels who continued to receive care within the system studied had diabetes diagnosed in the year after the index admission.

Conclusions: Nearly one in five adult patients admitted to a large general hospital had unrecognized probable diabetes, based on elevated HbA1c levels. Random glucose levels during the hospital stay were poorly predictive of this condition. Few hospitalized patients with elevated HbA1c levels were diagnosed within the year after admission.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study population. CBC, Complete blood count.
Figure 2
Figure 2
Receiver operating curve: random glucose and undiagnosed diabetes. Area under the curve = 0.60. P value for glucose predicting unrecognized probable diabetes = 0.07.
See this image and copyright information in PMC

References

    1. Aubert RE, Geiss LS, Ballard DJ, Cocanougher B, Herman WH 1995 Diabetes-related hospitalization and hospital utilization. In: Diabetes in America. 2nd ed. Bethesda, MD: National Institutes of Health; 553–569
    1. Baker EH, Janaway CH, Philips BJ, Brennan AL, Baines DL, Wood DM, Jones PW 2006 Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease. Thorax 61:284–289 - PMC - PubMed
    1. Kosiborod M, Rathore SS, Inzucchi SE, Masoudi FA, Wang Y, Havranek EP, Krumholz HM 2005 Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes. Circulation 111:3078–3086 - PubMed
    1. Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE 2002 Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab 87:978–982 - PubMed
    1. Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC 2001 Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke 32:2426–2432 - PubMed

Publication types