Preoperative "NPO" as an opportunity for diabetes screening.

BACKGROUND Novel preventive care opportunities, such as in hospitalized patients, may merit further investigation in an Accountable Care Organization (ACO) model. As 40% of patients with diabetes are undiagnosed, diabetes screening is an urgent public health need. Screening fasting preoperative patients may present an effective means to identify patients who might otherwise remain undiagnosed. OBJECTIVE To pilot an inpatient preventive care strategy for diabetes screening that would ascertain prevalence of unrecognized inpatient diabetes (DM) and impaired fasting glucose (IFG), determine reproducibility of preoperative fasting blood glucose (FBG), and establish feasibility of inpatient preventive screening. DESIGN Prospective observational study. SETTING Large Midwestern academic medical center. PATIENTS Two hundred seventy-five elective orthopedic patients with a preoperative visit between December 1, 2007 and November 30, 2008. Most patients (96.6%) had seen their primary care provider (PCP) within 12 months, and 100% were insured. MEASUREMENTS Medical history was recorded, and hemoglobin A(1C) (Hgb A(1C) ) and FBG were drawn immediately prior to surgery. Patients with preoperative FBG ≥100 mg/dL had FBG drawn 6-8 weeks postoperatively. RESULTS Twenty-four percent (67/275) of patients had previously unrecognized DM or IFG by virtue of 2 abnormal values. Sixty-four percent of patients with FBG ≥100 mg/dL preoperatively remained elevated at ambulatory follow-up. No patients with new DM or IFG had point-of-care glucose checks ordered or had dysglycemia mentioned on discharge summary. CONCLUSIONS Inpatient undiagnosed DM and IFG is common, even in insured, elective surgery patients with recent primary care visits. Preoperative FBG can be used to screen, but results need to be conveyed to PCPs.