Missed opportunities for diagnosis of diabetes

The objective of this study was to estimate the number of missed opportunities to diagnose abnormal glucose tolerance over a one‐year period in a district general hospital.

All patients with hyperglycaemia (≥ 7.0mmol/L) during one year were identified, and grouped by their glucose reading: 7.0–7.7mmol/L (group 1), 7.8–11.0mmol/L (group 2), and ≥ 11.1mmol/L (group 3). Patients with an HbA_1c result from six months either side of this period were excluded. A retrospective audit of action taken, following identification of hyperglycaemia, was conducted. The following year a similar population was identified, and 75g oral glucose tolerance tests (OGTTs) were carried out on a sample of these individuals.

Initially, 3424 hyperglycaemic results were identified. Eighty‐eight sets of case notes were audited. In group 1, 17/25 (68%) had a written record of hyperglycaemia; further action was taken in 0/25 (0%). In group 2, 15/26 (58%) had a written record of hyperglycaemia; further action was taken in 6/26 (23%). In group 3, 11/23 (48%) had a written record of hyperglycaemia; further action was taken in 11/23 (48%). Overall, 71/88 (81%) had no clarification of glycaemic status. Of those clarified 10/17 (59%) were abnormal. In the second cohort, 85 OGTTs were conducted; 14/31 (45%) of group 1, 12/27 (44%) of group 2 and 15/27 (56%) of group 3 had abnormal OGTT results.

In our Trust, unexpected hyperglycaemia confers a 48% risk of abnormal glucose tolerance, and a 21% risk of established diabetes. Current procedures failed to identify most of these patients. Other hospitals should review their procedures and data. Copyright © 2007 John Wiley & Sons.