Medicine (Austin & Northern Health) - Research Publications

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    Using Routine Hemoglobin A1c Testing to Determine the Glycemic Status in Psychiatric Inpatients
    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 (FRONTIERS MEDIA SA, 2017-03-28)
    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 30ā€‰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 (HbA1cā€‰ā‰„ā€‰6.5%, 48ā€‰mmol/mol), pre-diabetes (HbA1c 5.7-6.4%, 39-46ā€‰mmol/mol), or no diabetes (HbA1cā€‰ā‰¤ā€‰5.6%, 38ā€‰mmol/mol). Baseline characteristics, co-morbidities, psychiatric illnesses, and treatment were recorded. RESULTS: There were a total of 335 psychiatry inpatients (median age 41ā€‰years). The most prevalent diagnoses were schizophrenia, depression, and substance abuse. Of the 335 psychiatric inpatients, 14% (nā€‰=ā€‰46) had diabetes and 19% (nā€‰=ā€‰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 pā€‰ā‰¤ā€‰0.002). In multivariable analyses, diabetes was associated with increasing age (pā€‰=ā€‰0.02), substance abuse (pā€‰=ā€‰0.04), dyslipidaemia (pā€‰=ā€‰0.03), and aripiprazole use (pā€‰=ā€‰0.01). Patients with diabetes also had a 70% longer expected LOS (95% CI: 20-130%; pā€‰=ā€‰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.
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    Routine use of HbA1c amongst inpatients hospitalised with decompensated heart failure and the association of dysglycaemia with outcomes
    Khoo, K ; Lew, J ; Neef, P ; Kearney, L ; Churilov, L ; Robbins, R ; Tan, A ; Hachem, M ; Owen-Jones, L ; Lam, Q ; Hart, GK ; Wilson, A ; Sumithran, P ; Johnson, D ; Srivastava, PM ; Farouque, O ; Burrell, LM ; Zajac, JD ; Ekinci, EI (NATURE PUBLISHING GROUP, 2018-09-10)
    Diabetes is an independent risk factor for development of heart failure and has been associated with poor outcomes in these patients. The prevalence of diabetes continues to rise. Using routine HbA1c measurements on inpatients at a tertiary hospital, we aimed to investigate the prevalence of diabetes amongst patients hospitalised with decompensated heart failure and the association of dysglycaemia with hospital outcomes and mortality. 1191 heart failure admissions were identified and of these, 49% had diabetes (HbA1cā€‰ā‰„ā€‰6.5%) and 34% had pre-diabetes (HbA1c 5.7-6.4%). Using a multivariable analysis adjusting for age, Charlson comorbidity score (excluding diabetes and age) and estimated glomerular filtration rate, diabetes was not associated with length of stay (LOS), Intensive Care Unit (ICU) admission or 28-day readmission. However, diabetes was associated with a lower risk of 6-month mortality. This finding was also supported using HbA1c as a continuous variable. The diabetes group were more likely to have diastolic dysfunction and to be on evidence-based cardiac medications. These observational data are hypothesis generating and possible explanations include that more diabetic patients were on medications that have proven mortality benefit or prevent cardiac remodelling, such as renin-angiotensin system antagonists, which may modulate the severity of heart failure and its consequences.