A1c Testing in EDs Can Spot Undiagnosed Diabetes Cases
Among adults aged 30 years or older presenting to the emergency department (ED) without a prior diagnosis of type 2 diabetes (T2D), A1c testing combined with the Finnish Diabetes Risk Score (FINDRISC) identified a substantial proportion with prediabetes or diabetes — especially among those from ethnically diverse populations.
METHODOLOGY:
Researchers in England conducted a prospective study from December 2021 to December 2022 to determine the prevalence of glucose intolerance among 1382 individuals aged 30 years or older (45.1% men) who did not have a known diagnosis of diabetes and presented to the ED of a hospital in Manchester.
They also tested the utility of the FINDRISC in predicting the risk for diabetes in high-risk individuals.
Data on demographics, lifestyle factors, physical measurements, and A1c levels were collected, and the FINDRISC assessment was conducted by trained staff.
Patients were classified as those having normal glucose tolerance, prediabetes, or diabetes according to both National Institute for Health and Care Excellence (NICE) and American Diabetes Association (ADA) guidelines.
TAKEAWAY:
On the basis of the NICE criteria, 80.1% of attendees had normal glucose tolerance, 11.6% had prediabetes, and 8.3% had diabetes; on the basis of the ADA criteria, the corresponding percentages were 61.3%, 30.4%, and 8.3%, respectively.
Each unit increase in the FINDRISC was linked to an 8% (5%-12%) higher risk for prediabetes and a 16% (10%-23%) higher risk for diabetes, as per the NICE criteria, with similar findings seen for the ADA criteria as well; the risk remained elevated even after adjustment for confounders.
Compared with White individuals, British South Asian and other minority groups showed nearly twice the risk for prediabetes (relative risk ratio [RRR], 1.94; 95% CI, 1.11-3.38) and three times the risk for diabetes (RRR, 2.80; 95% CI, 1.61-4.84).
IN PRACTICE:
"The considerable prevalence of undiagnosed diabetes within our patient population highlights the critical need for routine HbA1c screening in this setting, which may be the only place where hard-to-reach individuals may attend for healthcare," the authors wrote.
SOURCE:
This study was led by Edward B. Jude, Tameside and Glossop Integrated Care, NHS Foundation Trust, Manchester, England. It was published online on August 06, 2025, in Diabetes Therapy.
LIMITATIONS:
The accuracy of A1c testing can be affected by conditions altering the quality or quantity of haemoglobin, such as anaemia or haemoglobinopathies, potentially leading to an underestimation of diabetes prevalence. Selection bias may exist as the study focused only on patients who underwent bloodwork in the ED. The single-centre nature of the study limited the generalisability of the results.
DISCLOSURES:
This study received partial funding from Sanofi Pharmaceuticals and Novo Nordisk. One author was supported by the 4Ward North Wellcome Trust Clinical Research Training Fellowship, and another author declared receiving travel and research grants from the funding agencies and other sources.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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