Screening for diabetes using HbA1c in elderly subjects

The objective of the study was to determine the prevalence of known diabetes among elderly subjects receiving nursing care in a north Norwegian population, to screen for new cases using HbA(1c) measurement and to evaluate the quality of care for those with diabetes. Men and women, with and without known diabetes, above 69 years and receiving nursing care either in an institution or in their own home in the municipality of Tromso, were included. A health questionnaire was administered and HbA(1c) measured. An oral glucose tolerance test (OGTT) was performed in those with HbA(1c)> 6.5% (upper reference limit). A total of 788 subjects were evaluated for participation and 228 completed the study. Forty-six subjects (20.2%) had a previous diagnosis of diabetes. Their age was 80.1 +/- 5.9 years (mean +/- SD) and HbA(1c) level 7.6 +/- 1.4%. Most patients had their blood glucose measured weekly and 65% used blood pressure medication; on average they were seen by their private doctor four times a year and annually by an ophthalmologist. Six subjects with undiagnosed diabetes had HbA(1c)> 6.5%. Diabetes was confirmed in one, excluded in two and further testing declined in three. None of these six subjects had HbA(1c)> 7.0%. In conclusion, there is a high prevalence of diabetes among elderly subjects needing nursing care. The prevalence of undiagnosed diabetes in need of treatment, as evaluated by the HbA(1c) level, was low, indicating that the focus on diabetes and quality of care for the elderly in our area is fairly good.