Scribd
Upload
36 views2 pages

Emergencykt:: Use of Hba1C in The Emergency Department

HbA1c measures average blood glucose over the past 3 months and can assess glycemic control in diabetic patients. Obtaining HbA1c in the emergency department for diabetic patients without primary care can help determine needed follow-up and improve management to reduce complications and unnecessary emergency visits. HbA1c levels correspond to average blood glucose and risk levels, and can identify undiagnosed diabetes or prediabetes.

Uploaded by

Artin Dervishi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
36 views2 pages

Emergencykt:: Use of Hba1C in The Emergency Department

HbA1c measures average blood glucose over the past 3 months and can assess glycemic control in diabetic patients. Obtaining HbA1c in the emergency department for diabetic patients without primary care can help determine needed follow-up and improve management to reduce complications and unnecessary emergency visits. HbA1c levels correspond to average blood glucose and risk levels, and can identify undiagnosed diabetes or prediabetes.

Uploaded by

Artin Dervishi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

EmergencyKT: Use of HbA1c in the Emergency Department

What is a Hemoglobin A1c (HbA1c)?


HbA1c represents a patient’s average glucose level over the last 1-4 months. HbA1c measures the percentage of glycosylated
hemoglobin in the blood and thus reflects the average glucose level over the life of a red blood cell (120 days) and the hemoglobin it
contains. Because of the constant turning over of red blood cells, more recent glucose levels (ie. the last few weeks) have a greater effect
on the HbA1c value than do those from 8 or 12 weeks ago. It is estimated that half of an HbA1c value is attributable to the previous
month’s glucose level, a further quarter to the month before that, and the other quarter to the two months before that. Since the HbA1c
value is not influenced by daily fluctuations in blood glucose concentration, it should not be used to monitor day-to-day blood glucose
concentrations and to adjust insulin treatment. Moreover, the HbA1c value may not reflect the day-to-day presence or absence of
hyperglycemia and/or hypoglycemia.

• HbA1c level may be falsely increased in patients with: kidney failure, chronic excessive alcohol intake (Vit B12 and foliate
deficiency), untreated iron deficient anemia, and hypertriglyceridemia

• HbA1c level may be falsely decreased in patients with: acute or chronic blood loss, sickle cell disease, hemolytic
anemia/thalassemia.

Why obtain an HbA1c in the Emergency Department?


Without primary care and proper diabetes management it is extremely difficult for many diabetics to control their glucose levels.
It is this lack of glycemic control that is ultimately responsible for the host of debilitating and potentially life threatening health
complications associated with poorly controlled diabetes. Diabetic patients who present to the emergency department (and who lack
adequate primary care or who are in need of improved diabetes management, education and/or follow up) should have their HbA1c level
obtained. The result can then be used to assess the patient’s current glycemic control and determine their urgency of needed follow up.
The implementation of this tool could significantly reduce the number of unnecessary emergency department visits by
decreasing the number of diabetic patients who use the emergency department as a means of obtaining primary care and by decreasing
the incidence and severity of diabetic related complications that require emergency department treatment. This also has the potential to
reduce costs by decreasing the number of emergency department visits and their related work ups.

HbA1c
< 5.0 5.4-6.4 6.5-7.0 7.1-8.0 8.1-9.0 9.1-11.9 > 12
%
Average Serum
Glucose < 81 94-127 130-147 150-180 184-214 217-310 > 314
mg/dL

Marginally
Managed
Diabetes

Take action to
Increased risk for lower average
Severely
severe glucose levels
Very Elevated
Known hypoglycemia
adverse events
Excellently
Controlled
Well
Controlled Note: HbA1c <
Poorly
Managed
Poorly
Diabetic Managed Extremely
including coma, Diabetes Diabetes 8% may be Diabetes
Diabetes Poor
seizures and appropriate for
Diabetes
death patients with a
Management
history of
severe
hypoglycemia,
advanced age
or severe
comorbidities.

(Pre Diabetic)
Borderline
New Onset Diabetes
Increased risk
Diabetes Diabetes Diabetes Diabetes
Unlikely Diabetes Likely Likely Likely Likely
Hyperglycemia for diabetes and
Likely
diabetes related
complications
Lifetime Benefits and Costs of Intensive Therapy as Practiced in the Diabetes Control and Complications Trial. The Journal of the
American Medical Association. 1996; 17:1409-1415

Ginde AA, Talley BE, Trent SA. Raja AS, Sullivan AF, Camargo CA. Referral of Discharged Emergency Department Patients to
Primary and Specialty Care Follow-up. Journal of Emergency Medicine. May 2011; Retrieved online on April 9, 2011 from website:
http://www.sciencedirect.com.proxy.libraries.uc.edu/science/article/pii/S0736467911010286

Standards of Medical Care in Diabetes – 2010. Diabetes Care. January 2010; 33:511-561

You might also like