Improving Diabetes and Pre-Diabetes Detection in the UK: Insights From HbA1c Screening in an Acute Hospital’s Emergency Department

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INTRODUCTION: Many individuals in the community have undiagnosed glucose intolerance, type 2 diabetes (T2D), and pre-diabetes (Pre-DM). This study explored screening for unknown glucose intolerance in the emergency department (ED) in an acute hospital. METHODS: 1382 persons attending the ED without T2D were screened using HbA1c. T2D and Pre-DM were classified using American Diabetes Association (ADA) and National Institute for Health and Care Excellence (NICE) criteria. The Finnish Diabetes Risk Score (FINDRISC) was calculated in all patients. RESULTS: According to NICE criteria, 80.1% (1107 individuals) exhibited normal glucose tolerance, 11.6% (160 individuals) exhibited pre-diabetes, and 8.3% (115 individuals) exhibited diabetes. Each unit increase in FINDRISC score, using multinomial regression, corresponded to an 8% (5-12%; p < 0.001) higher risk for pre-diabetes and a 16% (10-23%; p < 0.001) higher risk for diabetes (NICE). The risk remained elevated even after adjusting for age, sex, and ethnicity. South-Asians had higher glucose intolerance rates than white British (34.8% versus 18.5%) using the NICE criteria, and even greater at 50.0% versus 37.6% using ADA criteria. The adjusted relative risk of having pre-diabetes in people of color compared with white British individuals was 1.77 (1.04-3.00; p = 0.034, ADA) and 2.84 (1.41-5.65; p = 0.003, NICE). The multinomial relative-risk ratio (RRRs) for having diabetes by ethnicity was 2.97 (1.73-5.08; p < 0.0001, ADA) and 2.80 (1.59-4.94; p < 0.0001, NICE). CONCLUSIONS: Routine HbA1c screening in the ED, with FINDRISC scoring, successfully identifies individuals with diabetes and pre-diabetes. This approach could enable early intervention, particularly in groups at higher risk of glucose intolerance. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT04653545.

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