This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Diabetes is a chronic systemic disease which, over time, causes a severe and irreversible damage to the kidneys, heart, eyes, and other organs. The progression of such damage can be delayed or prevented through treatment to control blood sugar levels. Unfortunately, as many as half of all persons with diabetes do not know they have the disease and thus receive no treatment. Such patients are disproportionately found within minority and underserved populations, such as those that frequently seek care in hospital emergency departments. The purpose of this study is to identify patient and clinical characteristics which can be used to identify the at-risk patients most likely to benefit from formal screening for diabetes. This study is a prospective, observational study. Eligible patients will be identified by their clinical care providers in the emergency department, based on recognized risk factors for the subsequent identification of diabetes (e.g., body mass index [BMI], elevated blood glucose noted in the emergency department, family history). Clinical care providers will ask patients if they would be willing to speak with study personnel. Willing patients will then be approached by study personnel and written informed consent for participation will be sought. Those who agree to participate will then have additional laboratory tests obtained (chemistries, hemoglobin A1C, cortisol level) and additional clinical and demographic data will be obtained. Patients to be admitted to the hospital for serious medical and surgical illness, as defined in the protocol, will be excluded. After a period of 6 weeks, during which time patients will be expected to have recovered from their acute illness, patients will be brought back to the outpatient facility of the GCRC for follow-up testing. Follow-up testing will include additional blood work and either a formal fasting plasma glucose (FPG) or oral glucose tolerance test (OGTT). The oral glucose tolerance test consists of having the subject drink a sugary solution, followed by several blood samples to determine whether they have diabetes. Patients with positive results will be asked to return for a second visit during which they will undergo repeat testing. The ADA states that a diagnosis of diabetes needs to be confirmed on a separate day. Patients found to have diabetes on formal testing will be referred to appropriate primary care providers for management of their disease. In addition, medical records will be reviewed to obtain additional information of diagnosis and health care utilization for the prior and subsequent 6 months. Written informed consent will be obtained from all subjects prior to the initiation of any study-specific procedures and for the recording of protected healthcare information (PHI). Further, all data will be recorded without identifiers on data collection forms and stored in locked locations. A separate sheet identifying patients by study number will be kept in a different locked location. Information will only be entered into password-protected electronic databases and all information will be reported without patient identifiers. The study will be monitored in accordance with an approved data safety monitoring plan through the GCRC.
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