EMERGE: Evaluating the value of measuring random plasma glucose values for managing hyperglycemia in the inpatient setting

Abstract

Importance: A diagnosis of diabetes is considered when a patient has hyperglycemia with a random plasma glucose ≥200 mg/dL. However, in the inpatient setting, hyperglycemia is frequently non-specific, especially among patients who are acutely unwell. As a result, patients with transient hyperglycemia may be incorrectly labeled as having diabetes, leading to unnecessary treatment, and potential harm. Design, Setting, and Participants: We conducted a multicentre cohort study of patients hospitalized at seven hospitals in Ontario, Canada and identified those with a glucose value ≥200 mg/dL. We validated a definition for diabetes using manual chart review that included physician notes, pharmacy notes, home medications, and hemoglobin A1C. Among patients with a glucose value ≥200 mg/dL, we identified patients without diabetes who received a diabetes medication, and the number who experienced hypoglycaemia during the same admission. Main Outcomes and Measures:  To determine the diagnostic value of using random blood glucose to diagnose diabetes in the inpatient setting, and its impact on patient outcomes. Results: We identified 328,786 hospitalizations from hospital between 2010 and 2020. A blood glucose value of ≥200 mg/dL had a positive predictive value of 68% and a negative predictive value of 90% for a diagnosis of diabetes. Of the 76,967 patients with an elevated glucose value reported, 16,787 (21.8%) did not have diabetes, and of these, 5,375 (32%) received a diabetes medication. Hypoglycemia was frequently reported among the 5,375 patients that received a diabetes medication, with 1,406 (26.2%) experiencing hypoglycemia and 405 (7.5%) experiencing severe hypoglycemia. Conclusions and Relevance: Elevated plasma glucose in hospital is common but does not necessarily indicate a patient has diabetes. Furthermore, it can lead to treatment with diabetes medications with potential harm. Our findings highlight that clinicians should be cautious when responding to elevated random plasma glucose tests in the inpatient setting.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study was funded by the Banting & Best Diabetes Centre and the Sinai Department of Medicine research fund.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This research was approved through Clinical Trials Ontario (CTO) at Unity Health Toronto.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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Data Availability

All data produced in the present study are available upon reasonable request to the authors

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