Glycated hemoglobin (HbA1c) levels are a good indicator of the status of diabetes. In other words, when the value of HbA1c levels is 6.5% or more, it means the individual is diagnosed with diabetes. A value in the range of 5.7% and 6.4% indicates a diagnosis of prediabetes.
So, given such an effective detector of diabetes, there should be no issue in identifying people at risk of diabetes. In a way, you are right in thinking so. Outside the hospital, this is certainly a test used in diagnosing individuals at risk of diabetes. Strangely, however, this is not a test that is used in hospitals.
You would think hospitals would be the first place to use such a diagnostic test. But the setting in a hospital does not always promote the thought of performing an HbA1c test.
Let me explain this more clearly. Patients admitted to a hospital often display hyperglycemia due to various reasons. Some of the factors include medications (e.g. steroids or vasopressors), stress, administering intravenous or intramuscular nutrition, or conditions, such as acute myocardial infarction or sepsis. Most of the patients who have hyperglycemia due to these factors are not really treated for their hyperglycemia. It is largely ignored in the larger scheme of treating the main condition that is afflicting the patient.
Another striking feature of hyperglycemia in inpatients is that these patients tend to have a higher rate of mortality and actually have a longer recovery time in the hospital as compared with those patients who have already been diagnosed with diabetes and have hyperglycemia.
Hyperglycemia on its own predicts a poor outcome but doctors fail to associate hyperglycemia with the poor outcome specially if there is no clear diabetes diagnosis.
The authors of the study that has been published in the Journal of the American Osteopathic Association observed that the reluctance to test for glycated hemoglobin in hospitals may be due to a general delay in the patient following a treatment regimen for diabetes or the fact that they do not detect an abnormal reading on time or there is a delay in implementing treatment.
So, what the study wanted to see was the value of detecting HbA1c levels in the inpatient setting of the hospital. The study looked at 348 medical records of patients in a rural MidWest community hospital. The 348 patients were all diagnosed with hyperglycemia. Now, 50 of the 348 patients had “no known history of diabetes” (NKHB).
Thirty-one patients from this subset of 50 NKHB patients underwent an HbA1c test. The HbA1c test indicated that 58% of the patients had HbA1c levels that indicated risk of diabetes. Similarly, 19% of the patients had HbA1c levels that indicated risk of prediabetes. When these hyperglycemic patients were discharged from the hospital, 55% were diagnosed with diabetes.
On the other hand, 19 patients of the 50 NKHB patients did not have an HbA1c test despite the hyperglycemia. And so, when they were discharged, only 2 of them were given a clear diagnosis of diabetes.
The point behind this study is that patients could actually benefit from an early diagnosis of diabetes. They can take preventive measures and begin to act on their condition before it becomes worse.
A timely diagnosis improves the management strategies of the disease. This, in turn, prevents the condition from progressing and reduces the burden on the health machinery of the state.
The study has helped in making a strong case for the HbA1c test.
So, hospitals are urged to incorporate the HbA1c test I patients with hyperglycemia even if they do not have a diagnosis of diabetes.
