Diabetes mellitus is a major public health problem – the main cause of kidney failure, blindness, and nontraumatic leg amputations in adults in the U.S., and a leading cause of stroke and heart disease. Although early identification of diabetes and early treatment help to prevent or delay the development of diabetes complications, diagnosis may be delayed by as much as 6-12 years. Despite the potential cost-effectiveness of screening high-risk patients for diabetes, many healthcare systems have not yet implemented widespread screening. Additionally, in individuals with established diagnosis of diabetes, many do not meet recommended metabolic targets or receive preventive management.
Dr. Mary Rhee, an endocrinology specialist at the Atlanta VA, working in collaboration with other researchers, has been conducting epidemiologic studies of the national VA database. Her work seeks to identify factors that identify individuals at high risk for developing new diabetes and factors associated with diabetes complications in patients with known diabetes. For example, she investigated whether random glucose levels, included in routine blood tests in both the outpatient and inpatient settings, may provide a convenient, inexpensive way to identify individuals at high risk for developing diabetes. She found that in over 400,000 Veterans in the inpatient setting, having at least two hospital random glucose values above 140 mg/dL was associated with a 2.7-fold higher risk of developing diabetes within 3 years after discharge. Similarly, in a separate analysis of over 900,000 Veterans, patients having at least two outpatient random glucose levels of 110 or higher conferred a 4.9-fold increased 3-year risk. These findings showed that use of random glucose levels – obtained opportunistically, during outpatient visits or during hospitalizations – could signal the need for further testing, allow preventive intervention in high risk individuals before onset of disease, and lead to earlier identification of diabetes. Identifying convenient, cost effective methods, such as use of random glucose levels, for identifying individuals at high risk may help to diagnose diabetes earlier, start treatment sooner, and reduce complications.
Recent publications related to this research:
Rhee MK, Safo SE, Jackson SL, Xue W, Olson DE, Long Q, Barb D, Haw JS, Tomolo AM, Phillips LS. Inpatient glucose values: Determining the nondiabetic range and use in identifying patients at high risk for diabetes. Am J Med. 2018 Apr;131(4):443.e11-443.e24. PMID: 28993187
Rhee MK, Ho YL, Raghavan S, Vassy JL, Cho K, Gagnon D, Staimez LR, Ford CN, Wilson PWF, Phillips LS. Random plasma glucose predicts the diagnosis of diabetes. PLoS One. 2019 Jul 19;14(7):e0219964. PMID: 3132306