Professor Edward Jude from Tameside and Glossop Integrated Care NHS Foundation Trust presented preliminary data from the study ‘Diagnosing diabetes and assessing its prevalence in patients attending A&E in an acute hospital in England’, which is ongoing and now has a much larger population.  

He began with some stats – 4.3 million people in the UK have diabetes but there are about one million undiagnosed cases. Diagnosis can be delayed for up to eight years and long-term hyperglycaemia can increase the risk of type 2 diabetes complications. The prevalence in the community is around 9% but it’s much greater in people coming into hospital, with about 20-40% having diabetes, according to previous studies. Screening programmes are in place for diagnosis of type 2 diabetes but uptake is only around 50%. Patients attending hospital are currently not assessed routinely for diabetes. 

The aim of their study was therefore to assess prevalence of undiagnosed diabetes and glucose intolerance in people attending a busy A&E department in the UK. It was a prospective study involving 1388 patients aged over 30 who attended Tameside General Hospital between 2021 and 2022 and were not known to have diabetes. Patient demographics were obtained and they were asked about diet, exercise and comorbidities, and height and weight were measured. Blood pressure was measured in all patients and ethnicity was recorded. 

Blood was collected from the antecubital vein for blood glucose, lipids and renal function. HbA1c was measured using the HemoCue 501 POC machine from a fingertip blood test. The Finnish Diabetes Risk Score (FINDRISC) was calculated for all patients. Prediabetes and type 2 diabetes were diagnosed using both the American Diabetes Association (ADA) and National Institute for Health and Care Excellence (NICE) criteria. 

The cohort was 45.2% female and 54.7% male, 91.6% Caucasian and 8.4% non-Caucasian. The hospital is situated in a deprived part of the UK, said Professor Jude, and therefore had a high proportion of current/previous smokers at 59.6%. Prevalence of prediabetes and type 2 diabetes was 37.8% for Caucasians and 42.7% for non-Caucasians (South Asian and African Caribbean). 

The results differed according to whether ADA or NICE criteria was used. Under NICE criteria (HbA1c 42-47 mmol/mol is prediabetes and > 48 mmol/mol is type 2 diabetes), 11.7% of people had prediabetes and 8.9% had type 2 diabetes. Under ADA criteria (HbA1c 39-47 mmol/mol is prediabetes and > 48 mmol/mol is type 2 diabetes), 30.4% had prediabetes and 8.9% had type 2 diabetes. There was no difference in sex distribution. BMI did not differ significantly between those with normal HbA1c and those with prediabetes, but those with type 2 diabetes were in the obese range. 

The FINDRISC was used to calculate the odds ratios (scoring > 20 puts you at very high risk – 50% chance of developing type 2 diabetes in the next 10 years). In the > 20 category under NICE criteria, the odds ratio was 6.09; under ADA criteria, they picked up more people with prediabetes at lower risk scores with an odds ratio of 22.17. When the results were adjusted for ethnicity, it showed that non-Caucasian people were at higher risk of developing type 2 diabetes. 

In conclusion:

  • Prediabetes is increasing and we need to identify people at risk or those not known to have diabetes so that earlier treatment can be instituted
  • The uptake of community screening programmes for diabetes is low. Therefore, people attending A&E can be opportunistically tested for diabetes with a simple and inexpensive blood test (HbA1c)
  • The researchers identified high prevalence of glucose intolerance in patients attending A&E
  • Risk scores should take ethnicity into consideration
  • Screening for diabetes could be performed in all adult patients attending A&E and should be incorporated into guidelines 
  • Early diagnosis and treatment will reduce burden on healthcare services and the patient in the long-term

To learn more, enrol on the EASD e-Learning course ‘Management of hyperglycaemia in type 2 diabetes’.

Any opinions expressed in this article are the responsibility of the EASD e-Learning Programme Director, Dr Eleanor D Kennedy.