Follow-up of patients with hyperglycemia in the emergency department without a history of diabetes mellitus

• A substantial percentage (2.9%) of our non-diabetic ED study population had hyperglycemia.
• Hyperglycemia in ED patients is often overlooked and unaddressed.
• It is important to develop guidelines for the management of hyperglycemia in the ED.

ObjectivesThe aim of this study is to determine the prevalence of hyperglycemia in emergency department patients without a history of diabetes mellitus, and to investigate whether these patients were referred to a general practitioner or to the outpatient clinic for follow-up with further diagnostic testing and treatment.MethodsWe conducted a retrospective cohort pilot study of adult patients who were seen at the emergency department of an urban academic hospital in the Netherlands between the 1st of January and the 29th of February 2008, who had an initial (unknown fasting or non-fasting) plasma glucose level ≥ 7.8 mmol/L (140 mg/dL). The medical records of these patients were retrieved to evaluate whether these patients were referred for follow-up.ResultsDuring the data collecting period 5317 patients presented at the ED, 343 of these patients were identified with a plasma glucose ≥ 7.8 mmol/L. Using exclusion criteria, eventually 154 patients were included in this study. The prevalence of incidentally found hyperglycemia in emergency department patients without a history of diabetes mellitus in this period was 2.9%.For 98.7% of the hyperglycemic patients no follow-up was arranged by the treating physician. None of the patients was treated with a hypoglycemic agent in the emergency department.ConclusionA substantial percentage (2.9%) of our study population had hyperglycemia and thus was at risk for undiagnosed diabetes mellitus and prediabetes. To date, recognition and follow-up of hyperglycemia in emergency department patients is poor. We presume that major health benefits may be achieved when the follow-up of hyperglycemia is performed more frequently.