1309-P: Diagnosing Glucose Intolerance in Patients Attending ER in an Acute Hospital in England

Introduction and Objective: Type 2 diabetes (T2D) and pre-diabetes (pre-D) are associated with greater risk of cardiovascular disease and mortality. Therefore, early diagnosis of glucose intolerance is important. Patients attending hospital can be screened for diabetes to identify those who will benefit from early treatment and future risk reduction. The aim of this study was to screen people attending Emergency Room (ER), not known to have T2D.

Methods: 3425 individuals (1935 women) were screened for pre-D and T2D using HbA1c at presentation. Demographics, including ethnicity, were also recorded and the Finnish Diabetes Risk Score (FINDRISC) was calculated. Glucose intolerance was defined according to ADA criteria (pre-D: HbA1c 39-47 and T2D: ≥48mmol/mol).

Results: Normal glucose tolerance (NGT) was seen in 1967 people (58.5%), pre-D in 1190 (30.2%) and T2D in 263 (7.8%). Mean (SE) age was: NGT 50.3 (0.32), pre-D 57.4 (0.41) and T2D 57.4 (0.87) years, respectively (P<0.0001). Mean HbA1c: NGT 34.1 (0.1), pre-D 41.5 (0.1), T2D 57.6 (0.3) mmol/mol, respectively (p<0.001). Mean weight and BMI was: NGT 80.5 (0.5), pre-D 82.3 (0.6) and T2D 90.2 (1.6) kg, respectively (p<0.0001) and 28.4 (0.2), 29.2 (0.2) and 31.6 (0.4), respectively (p=0.0001). In a multinomial univariable logistic regression model for each unit increase in FINDRISC score the RRR (95% CI) for pre-D was 1.09 (1.06, 1.11) and for T2D 1.16 (1.11, 1.21). On adjusting for age and sex the RRR was 1.09 (1.08, 1.11) and 1.16 (1.13, 1.20) for pre-D and T2D, respectively (p<0.001). FINDRISC of >20 increased risk for pre-D and T2D 14.2 and 15.4-fold, respectively. South Asians had higher rates of glucose intolerance compared to Caucasians (32.9% vs 22.1%).

Conclusion: Patients attending ER have a high incidence of unknown glucose intolerance. The FINDRSC score may be used to identify those at risk. Use of HbA1c in ER is a practical and effective way of identifying previously unknown pre-D and T2D, leading to prompt implementation of targeted treatment.