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Title: Routine HbA1c among hematology and oncology inpatients: Diabetes-status and hospital-outcomes.
Austin Authors: Chiu, Wei-Ling;Churilov, Leonid ;Lim, Chee-Hau;Tan, Alanna ;Nedumannil, Rithin;Lau, Lik-Hui;Lew, Jeremy;Hachem, Mariam;Kong, Alvin;Robbins, Raymond J ;Sutcliffe, Harvey;Lam, Que T ;Lee, Andrew;Djukiadmodjo, Frida;Nanayakkara, Natalie;Zajac, Jeffrey D ;Ekinci, Elif I 
Affiliation: Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
Clinical Informatics Unit, Austin Health, Heidelberg, Victoria, Australia
Pathology IT Service, Austin Pathology, Austin Health, Heidelberg, Victoria, Australia
Department of Strategy, Quality & Service Redesign, Austin Health, Heidelberg, Victoria, Australia
Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Issue Date: 10-May-2019 2019-05-10
Publication information: Diabetes research and clinical practice 2019; 152: 71-78
Abstract: Using routine HbA1c measurement to determine the prevalence of diabetes mellitus (known and previously unrecognized) and their hospital outcomes among hematology and oncology inpatients. This was a prospective, observational study. Routine automated HbA1c testing was performed in all hematology and oncology inpatients aged ≥54 years at a tertiary hospital, July 2013-January 2015. The outcome measures were: (i) prevalence of known and previously unrecognized diabetes, and (ii) hospital outcomes: length-of-stay (LOS), intensive-care-unit (ICU) admission, 30-day/18-month readmission, and 18-month mortality. Over the 18-month study period, 1076 inpatients aged ≥54 years were admitted to hematology (n = 298) and oncology (n = 778) units: 21% had known diabetes and 7% had previously unrecognized diabetes. Patients with known diabetes had a longer LOS (IRR: 1.18, 95%CI: 1.02-1.37, p = 0.03), compared to those without diabetes, adjusting for age, hemoglobin level, estimated-glomerular-filtration-rate, admission specialty unit, Charlson's comorbidity index score, and glucocorticoid exposure. No significant differences were observed in ICU admission, 30-day/18-month readmission, and 18-month mortality among patients with known, previously unrecognized and no diabetes (p ≥ 0.05). Approximately one in five hematology or oncology inpatients aged ≥54 years had known diabetes, and one in fourteen had previously unrecognized diabetes. Those with known diabetes had a longer hospital stay. Routine HbA1c measurement is can be useful for identifying previously unrecognized diabetes, particularly among patients with high glucocorticoid exposure. Further study is required to determine cost-effectiveness in screening for unrecognized diabetes and optimal management of these patients.
DOI: 10.1016/j.diabres.2019.05.002
ORCID: 0000-0003-2372-395X
Journal: Diabetes research and clinical practice
PubMed URL: 31082446
Type: Journal Article
Subjects: Hematology inpatients
Hospital outcomes
Known diabetes
Oncology inpatients
Routine HbA1c
Unrecognized diabetes
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