Inpatient HbA1c testing: a prospective observational study.
Inpatient HbA1c testing: a prospective observational study.
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DOI：
10.1136/bmjdrc-2015-000113
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发表时间：
2015
影响因子：
4.1
通讯作者：
Ekinci EI
中科院分区：
文献类型：
--
作者：
Nanayakkara N;Nguyen H;Churilov L;Kong A;Pang N;Hart GK;Owen-Jones E;White J;Ross J;Stevenson V;Bellomo R;Lam Q;Crinis N;Robbins R;Johnson D;Baker ST;Zajac JD;Ekinci EI
使用入院住院患者糖化血红蛋白（HbA 1c）检测来帮助调查未识别糖尿病的患病率、未识别和已知糖尿病的累积患病率以及两者中血糖控制不良的患病率。此外，我们的目的是确定这些患者的6个月结局。最后，我们的目的是评估糖尿病与这些结果的独立关联。在澳大利亚墨尔本的一家三级医院进行的前瞻性观察性队列研究。2013年7月至2014年1月期间入院的5082例≥54岁住院患者队列接受了HbA 1c测量。从医院病历中获得既往糖尿病诊断。患者随访延长至6个月。 糖尿病（已知和未识别）的患病率为34%。特别是，我们在271例（5%，95% CI 4.7%-6.0%）患者中发现了未识别但经HbA 1c证实的糖尿病，在1452例（29%，95% CI 27.3%-29.8%）患者中发现了既往已知的糖尿病;在3359例（66%，95% CI 64.8-67.4%）患者中发现了无糖尿病。总体而言，17%（95% CI 15.3%-18.9%）HbA 1c>6.5%的患者的HbA 1c ≥ 8.5%。调整年龄、性别、Charlson指数评分、估计肾小球滤过率和血红蛋白水平后，以入院单位作为随机效应，既往已知糖尿病患者的6个月死亡率较低（OR 0.69，95%CI 0.56 - 0.87，p=0.001）。然而，3组之间在6个月内入住重症监护室、机械通气或再入院的比例无显著差异。 在所有≥54岁的住院患者中，约有三分之一患有糖尿病，其中约六分之一先前未被识别。 此外，血糖控制不良也很常见。两组间重症监护室入院、机械通气或再入院的比例相似。最后，糖尿病与较低的6个月死亡率独立相关。
To use admission inpatient glycated hemoglobin (HbA1c) testing to help investigate the prevalence of unrecognized diabetes, the cumulative prevalence of unrecognized and known diabetes, and the prevalence of poor glycemic control in both. Moreover, we aimed to determine the 6-month outcomes for these patients. Finally, we aimed to assess the independent association of diabetes with these outcomes. Prospective observational cohort study conducted in a tertiary hospital in Melbourne, Australia. A cohort of 5082 inpatients ≥54 years admitted between July 2013 and January 2014 underwent HbA1c measurement. A previous diagnosis of diabetes was obtained from the hospital medical record. Patient follow-up was extended to 6 months. The prevalence of diabetes (known and unrecognized) was 34%. In particular, we identified that unrecognized but HbA1c-confirmed diabetes in 271 (5%, 95% CI 4.7% to 6.0%) patients, previously known diabetes in 1452 (29%, 95% CI 27.3% to 29.8%) patients; no diabetes in 3359 (66%, 95% CI 64.8–67.4%) patients. Overall 17% (95% CI 15.3% to 18.9%) of patients with an HbA1c of >6.5% had an HbA1c ≥8.5%. After adjusting for age, gender, Charlson Index score, estimated glomerular filtration rate, and hemoglobin levels, with admission unit treated as a random effect, patients with previously known diabetes had lower 6-month mortality (OR 0.69, 95% CI 0.56 to 0.87, p=0.001). However, there were no significant differences in proportions of intensive care unit admission, mechanical ventilation or readmission within 6 months between the 3 groups. Approximately one-third of all inpatients ≥54 years of age admitted to hospital have diabetes of which about 1 in 6 was previously unrecognized. Moreover, poor glycemic control was common. Proportions of intensive care unit admission, mechanical ventilation, or readmission were similar between the groups. Finally, diabetes was independently associated with lower 6-month mortality.