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Original Articles

Unrecognized Diabetes Among Hospitalized Patients

  1. Claresa S Levetan, MD,
  2. Maureen Passaro, MD,
  3. Kathleen Jablonski, PHD,
  4. Mary Kass, MD and
  5. Robert E Ratner, MD
  1. Medlantic Research Institute Washington, DC
  2. Washington Hospital Center Washington, DC
  1. Address correspondence and reprint requests to Dr. Claresa Levetan, Medlantic Research Institute, 650 Pennsylvania Ave., SE, Suite 50, Washington, DC 20003.
Diabetes Care 1998 Feb; 21(2): 246-249. https://doi.org/10.2337/diacare.21.2.246
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Abstract

OBJECTIVE To evaluate the hospital care rendered to hyperglycemic individuals who did not have a diagnosis of diabetes before admission.

RESEARCH DESIGN AND METHODS A total of 1,034 consecutively hospitalized adult patients at a 750-bed inner-city teaching hospital were evaluated. Patients with one or more plasma glucose values >200 mg/dl were identified by the laboratory data system on a daily basis. Patients without a diagnosis of diabetes at the time of admission were evaluated to determine if and how physicians addressed the hyperglycemia, whether a new diagnosis of diabetes was made during admission, and whether follow-up was planned to address the hyperglycemia.

RESULTS After excluding patients who were admitted for a primary diagnosis of diabetes, 37.5% of all hyperglycemic medical patients and 33% of hyperglycemic surgical patients were without a diagnosis of diabetes at the time of admission. These patients had a mean peak glucose of 299 mg/dl, and 66% had two or more elevated values during their hospitalization. Fifty-four percent received insulin therapy, and 59% received bedside glucose monitoring, yet 66% of daily patient progress notes failed to comment on the presence of hyperglycemia or diabetes. Diabetes was documented in only three patients (7.3%) as a possible diagnosis in the daily progress notes.

CONCLUSIONS Despite marked hyperglycemia, most medical records made no reference to the possibility of unrecognized diabetes. Given the average delay of a decade between the onset and diagnosis of type 2 diabetes, further evaluation of hyperglycemic hospitalized patients may present an important opportunity for earlier detection and the initiation of therapy.

  • Received May 21, 1997.
  • Revision received October 21, 1997.
  • Accepted October 21, 1997.
  • Copyright © 1998 by the American Diabetes Association

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February 1998, 21(2)
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Unrecognized Diabetes Among Hospitalized Patients
Claresa S Levetan, Maureen Passaro, Kathleen Jablonski, Mary Kass, Robert E Ratner
Diabetes Care Feb 1998, 21 (2) 246-249; DOI: 10.2337/diacare.21.2.246

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Unrecognized Diabetes Among Hospitalized Patients
Claresa S Levetan, Maureen Passaro, Kathleen Jablonski, Mary Kass, Robert E Ratner
Diabetes Care Feb 1998, 21 (2) 246-249; DOI: 10.2337/diacare.21.2.246
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