Using routine hemoglobin A1c testing to determine the glycemic status in psychiatric inpatients

Pratyusha Naidu; Leonid Churilov; Alvin Kong; Richard Kanaan; Henry Wong; Arielle Van Mourik; Anthony Yao; Elizabeth Cornish; Mariam Hachem; Graeme Kevin Hart; Elizabeth Owen-Jones; Raymond Robbins; Que Lam; Katherine Samaras; Jeffrey D. Zajac; Elif I. Ekinci

doi:10.3389/fendo.2017.00053

Using routine hemoglobin A1c testing to determine the glycemic status in psychiatric inpatients

Pratyusha Naidu, Leonid Churilov, Alvin Kong, Richard Kanaan, Henry Wong, Arielle Van Mourik, Anthony Yao, Elizabeth Cornish, Mariam Hachem, Graeme Kevin Hart, Elizabeth Owen-Jones, Raymond Robbins, Que Lam, Katherine Samaras, Jeffrey D. Zajac, Elif I. Ekinci

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Abstract

Aim: Using routine hemoglobin A1c (HbA1c) testing to describe the prevalence, characteristics, and length of stay (LOS) of psychiatry inpatients with type 2 diabetes compared to those with pre-diabetes and those without diabetes.

Methods: In this prospective observational study, all inpatients aged greater than 30 years admitted to the Austin Health Psychiatry Unit, a major tertiary hospital, affiliated with the University of Melbourne, between February 2014 and April 2015 had routine HbA1c testing as part of the Diabetes Discovery Initiative. Patients were divided into three groups: diabetes (HbA1c≥6.5%, 48 mmol/mol), pre-diabetes (HbA1c 5.7-6.4%, 39-46 mmol/mol), or no diabetes (HbA1c ≤ 5.6%, 38 mmol/mol). Baseline characteristics, co-morbidities, psychiatric illnesses, and treatment were recorded.

Results: There were a total of 335 psychiatry inpatients (median age 41 years). The most prevalent diagnoses were schizophrenia, depression, and substance abuse. Of the 335 psychiatric inpatients, 14% (n = 46) had diabetes and 19% (n = 63) had pre-diabetes, a prevalence threefold greater than in the aged matched general population. Compared to inpatients with pre-diabetes and no diabetes, those with diabetes were older and were at least twice as likely to have hypertension, obesity, and hyperlipidemia (all p ≤ 0.002). In multivariable analyses, diabetes was associated with increasing age (p = 0.02), substance abuse (p = 0.04), dyslipidaemia (p = 0.03), and aripiprazole use (p = 0.01). Patients with diabetes also had a 70% longer expected LOS (95% CI: 20-130%; p = 0.001), compared to those with pre-diabetes and no diabetes.

Conclusion: Despite relative youth, one-third of all psychiatric inpatients above the age of 30 have diabetes or pre-diabetes. Presence of diabetes in psychiatric inpatients is associated with older age, substance abuse, and longer LOS. Routine inpatient HbA1c testing provides an opportunity for early detection and optimization of diabetes care.

Original language	English
Article number	53
Pages (from-to)	1-8
Number of pages	8
Journal	Frontiers in Endocrinology
Volume	8
DOIs	https://doi.org/10.3389/fendo.2017.00053
Publication status	Published - 28 Mar 2017

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9182591-oaFinal published version, 808 KBLicence: CC BY

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Naidu, P., Churilov, L., Kong, A., Kanaan, R., Wong, H., Van Mourik, A., Yao, A., Cornish, E., Hachem, M., Hart, G. K., Owen-Jones, E., Robbins, R., Lam, Q., Samaras, K., Zajac, J. D., & Ekinci, E. I. (2017). Using routine hemoglobin A1c testing to determine the glycemic status in psychiatric inpatients. Frontiers in Endocrinology, 8, 1-8. [53]. https://doi.org/10.3389/fendo.2017.00053

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title = "Using routine hemoglobin A1c testing to determine the glycemic status in psychiatric inpatients",

abstract = "Aim: Using routine hemoglobin A1c (HbA1c) testing to describe the prevalence, characteristics, and length of stay (LOS) of psychiatry inpatients with type 2 diabetes compared to those with pre-diabetes and those without diabetes. Methods: In this prospective observational study, all inpatients aged greater than 30 years admitted to the Austin Health Psychiatry Unit, a major tertiary hospital, affiliated with the University of Melbourne, between February 2014 and April 2015 had routine HbA1c testing as part of the Diabetes Discovery Initiative. Patients were divided into three groups: diabetes (HbA1c≥6.5%, 48 mmol/mol), pre-diabetes (HbA1c 5.7-6.4%, 39-46 mmol/mol), or no diabetes (HbA1c ≤ 5.6%, 38 mmol/mol). Baseline characteristics, co-morbidities, psychiatric illnesses, and treatment were recorded. Results: There were a total of 335 psychiatry inpatients (median age 41 years). The most prevalent diagnoses were schizophrenia, depression, and substance abuse. Of the 335 psychiatric inpatients, 14% (n = 46) had diabetes and 19% (n = 63) had pre-diabetes, a prevalence threefold greater than in the aged matched general population. Compared to inpatients with pre-diabetes and no diabetes, those with diabetes were older and were at least twice as likely to have hypertension, obesity, and hyperlipidemia (all p ≤ 0.002). In multivariable analyses, diabetes was associated with increasing age (p = 0.02), substance abuse (p = 0.04), dyslipidaemia (p = 0.03), and aripiprazole use (p = 0.01). Patients with diabetes also had a 70% longer expected LOS (95% CI: 20-130%; p = 0.001), compared to those with pre-diabetes and no diabetes. Conclusion: Despite relative youth, one-third of all psychiatric inpatients above the age of 30 have diabetes or pre-diabetes. Presence of diabetes in psychiatric inpatients is associated with older age, substance abuse, and longer LOS. Routine inpatient HbA1c testing provides an opportunity for early detection and optimization of diabetes care.",

keywords = "Atypical antipsychotics, Diabetes, Obesity, Pre-diabetes, Psychiatry inpatients",

author = "Pratyusha Naidu and Leonid Churilov and Alvin Kong and Richard Kanaan and Henry Wong and {Van Mourik}, Arielle and Anthony Yao and Elizabeth Cornish and Mariam Hachem and Hart, {Graeme Kevin} and Elizabeth Owen-Jones and Raymond Robbins and Que Lam and Katherine Samaras and Zajac, {Jeffrey D.} and Ekinci, {Elif I.}",

year = "2017",

month = mar,

day = "28",

doi = "10.3389/fendo.2017.00053",

language = "English",

volume = "8",

pages = "1--8",

journal = "Frontiers in Endocrinology",

issn = "1664-2392",

publisher = "Frontiers Media S.A.",

}

Naidu, P, Churilov, L, Kong, A, Kanaan, R, Wong, H, Van Mourik, A, Yao, A, Cornish, E, Hachem, M, Hart, GK, Owen-Jones, E, Robbins, R, Lam, Q, Samaras, K, Zajac, JD & Ekinci, EI 2017, 'Using routine hemoglobin A1c testing to determine the glycemic status in psychiatric inpatients', Frontiers in Endocrinology, vol. 8, 53, pp. 1-8. https://doi.org/10.3389/fendo.2017.00053

TY - JOUR

T1 - Using routine hemoglobin A1c testing to determine the glycemic status in psychiatric inpatients

AU - Naidu, Pratyusha

AU - Churilov, Leonid

AU - Kong, Alvin

AU - Kanaan, Richard

AU - Wong, Henry

AU - Van Mourik, Arielle

AU - Yao, Anthony

AU - Cornish, Elizabeth

AU - Hachem, Mariam

AU - Hart, Graeme Kevin

AU - Owen-Jones, Elizabeth

AU - Robbins, Raymond

AU - Lam, Que

AU - Samaras, Katherine

AU - Zajac, Jeffrey D.

AU - Ekinci, Elif I.

PY - 2017/3/28

Y1 - 2017/3/28

N2 - Aim: Using routine hemoglobin A1c (HbA1c) testing to describe the prevalence, characteristics, and length of stay (LOS) of psychiatry inpatients with type 2 diabetes compared to those with pre-diabetes and those without diabetes. Methods: In this prospective observational study, all inpatients aged greater than 30 years admitted to the Austin Health Psychiatry Unit, a major tertiary hospital, affiliated with the University of Melbourne, between February 2014 and April 2015 had routine HbA1c testing as part of the Diabetes Discovery Initiative. Patients were divided into three groups: diabetes (HbA1c≥6.5%, 48 mmol/mol), pre-diabetes (HbA1c 5.7-6.4%, 39-46 mmol/mol), or no diabetes (HbA1c ≤ 5.6%, 38 mmol/mol). Baseline characteristics, co-morbidities, psychiatric illnesses, and treatment were recorded. Results: There were a total of 335 psychiatry inpatients (median age 41 years). The most prevalent diagnoses were schizophrenia, depression, and substance abuse. Of the 335 psychiatric inpatients, 14% (n = 46) had diabetes and 19% (n = 63) had pre-diabetes, a prevalence threefold greater than in the aged matched general population. Compared to inpatients with pre-diabetes and no diabetes, those with diabetes were older and were at least twice as likely to have hypertension, obesity, and hyperlipidemia (all p ≤ 0.002). In multivariable analyses, diabetes was associated with increasing age (p = 0.02), substance abuse (p = 0.04), dyslipidaemia (p = 0.03), and aripiprazole use (p = 0.01). Patients with diabetes also had a 70% longer expected LOS (95% CI: 20-130%; p = 0.001), compared to those with pre-diabetes and no diabetes. Conclusion: Despite relative youth, one-third of all psychiatric inpatients above the age of 30 have diabetes or pre-diabetes. Presence of diabetes in psychiatric inpatients is associated with older age, substance abuse, and longer LOS. Routine inpatient HbA1c testing provides an opportunity for early detection and optimization of diabetes care.

AB - Aim: Using routine hemoglobin A1c (HbA1c) testing to describe the prevalence, characteristics, and length of stay (LOS) of psychiatry inpatients with type 2 diabetes compared to those with pre-diabetes and those without diabetes. Methods: In this prospective observational study, all inpatients aged greater than 30 years admitted to the Austin Health Psychiatry Unit, a major tertiary hospital, affiliated with the University of Melbourne, between February 2014 and April 2015 had routine HbA1c testing as part of the Diabetes Discovery Initiative. Patients were divided into three groups: diabetes (HbA1c≥6.5%, 48 mmol/mol), pre-diabetes (HbA1c 5.7-6.4%, 39-46 mmol/mol), or no diabetes (HbA1c ≤ 5.6%, 38 mmol/mol). Baseline characteristics, co-morbidities, psychiatric illnesses, and treatment were recorded. Results: There were a total of 335 psychiatry inpatients (median age 41 years). The most prevalent diagnoses were schizophrenia, depression, and substance abuse. Of the 335 psychiatric inpatients, 14% (n = 46) had diabetes and 19% (n = 63) had pre-diabetes, a prevalence threefold greater than in the aged matched general population. Compared to inpatients with pre-diabetes and no diabetes, those with diabetes were older and were at least twice as likely to have hypertension, obesity, and hyperlipidemia (all p ≤ 0.002). In multivariable analyses, diabetes was associated with increasing age (p = 0.02), substance abuse (p = 0.04), dyslipidaemia (p = 0.03), and aripiprazole use (p = 0.01). Patients with diabetes also had a 70% longer expected LOS (95% CI: 20-130%; p = 0.001), compared to those with pre-diabetes and no diabetes. Conclusion: Despite relative youth, one-third of all psychiatric inpatients above the age of 30 have diabetes or pre-diabetes. Presence of diabetes in psychiatric inpatients is associated with older age, substance abuse, and longer LOS. Routine inpatient HbA1c testing provides an opportunity for early detection and optimization of diabetes care.

KW - Atypical antipsychotics

KW - Diabetes

KW - Obesity

KW - Pre-diabetes

KW - Psychiatry inpatients

UR - http://www.scopus.com/inward/record.url?scp=85017148108&partnerID=8YFLogxK

U2 - 10.3389/fendo.2017.00053

DO - 10.3389/fendo.2017.00053

M3 - Article

C2 - 28396652

AN - SCOPUS:85017148108

VL - 8

SP - 1

EP - 8

JO - Frontiers in Endocrinology

JF - Frontiers in Endocrinology

SN - 1664-2392

M1 - 53

ER -

Using routine hemoglobin A1c testing to determine the glycemic status in psychiatric inpatients

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